The Bulletin: July 2007

The Bulletin is a monthly newsletter for Children's and community providers.

Immunization Requirements for Medical Staff Members Changed

At its meeting in May, the Medical Executive Committee approved updated immunization requirements for members of Children’s medical staff.

The immunization requirements for medical staff and other Children’s hospital staff are comparable to those of other area hospitals. To view the requirements for area hospitals, see the comparison table.

The requirements will be implemented on Oct. 1, 2007 for all new medical staff applicants and Feb. 2, 2008, for all reappointments.

Physicians who need immunizations or testing will be directed to obtain them from their own physician or from Children’s Occupational Health Services (OHS). Children’s will offer free immunizations and/or serologic testing for immunity to hepatitis B, measles, mumps, rubella and varicella, as well as tuberculosis screening, to medical staff applicants and members.

Applicants and members who have medical, religious or other contraindications to any required immunizations should review these concerns with OHS staff.

OHS is located in the Bret Boone Modular on the main hospital campus, room M104. You can reach OHS at (206) 987-2555, or by fax at (206) 987-5162. OHS is open on Monday, Tuesday, Wednesday and Friday from 7:30 am to noon and from 1 to 3 p.m., and on Thursday from 7:30 a.m. to noon.

Quarterly Consult: Sleep Disorders in Children

Dr. Maida Chen explains treatment options for common sleep-related issues — and when to refer a patient for a sleep study at Children’s — in the Quarterly Consult.

Standardizing Handoffs to Improve Patient Safety

Communication problems during patient handoffs are known to be a leading cause of adverse events that result in harm to patients.

A Joint Commission evaluation found that more than 65% of sentinel events in accredited institutions were caused by communication problems, and at least half of these problems occurred during handoffs.

To address these safety concerns, Dr. Ed Marcuse, associate medical director, and a group of faculty and residents have developed a standardized process for physician-to-physician patient handoffs.

The process stipulates that the handoff must include interactive communication — in other words, the chance to ask questions and have them answered — between the giver and receiver of patient information prior to the transfer of clinical responsibility.

Based on Joint Commission requirements, this new process will be implemented in phases and will apply to all physician-to-physician handoffs for hospitalized children. Plans call for all inpatient clinical services to be on board in September 2007.

The new guidelines specify that all physician-to-physician handoffs must:

1. Communicate the following information in this order:

Patient’s name
Patient’s age or birth date
Current and planned patient locations
Language preference if not English
Attending physician

2. List current (active) clinical problems, and a plan for each to include:

“To do” list, e.g. list of actions to be completed during the next care interval
“If, then” recommendations, e.g., “if fever, obtain a blood culture”
Who to call if assistance is needed.

3. Include an opportunity for interactive communication between the giver and receiver of patient information prior to the transfer of clinical responsibility.

More information about these new guidelines will be provided through your department in the next few weeks.

Well-Being Committee Available for Medical Staff Members

The Practitioner Well-Being Committee (PWBC) is an advocacy committee for distressed members of the medical staff. Committee members represent various Children’s departments and include Children’s faculty and community medical staff members.

The committee is charged with reviewing reports or complaints related to the health, well-being or health-related impairments of medical staff members. The committee can provide advice and recommendations to medical staff members in distress, including advocacy, support and education.

For example, assistance is provided to members in need of referral for mental health or substance use problems, helping those individuals navigate the often confusing array of services and practitioners in these specialty areas.

The committee helps members whose health problems have affected their medical practice, providing a confidential, supportive alternative to hospital disciplinary processes for the assessment and resolution of such problems.

The committee can also provide consultation to department chairs and other faculty administrators in their efforts to identify and support physicians showing early signs of distress or impairment. If you would like more information, please contact Matthew Speltz, PhD, committee chair, at (206) 987-7577, or any of the following committee members:

Cora Breuner, MD, (206) 987-3049
Michael Cunningham, MD, (206) 987-2528
Steve Dassel, MD, (206) 525-8000
Michael Dudas, MD, (206) 525-8000
Russ Geyer, MD, (206) 987-6664
Christer Jonmarker, MD, (206) 987-2518
Kathleen Sie, MD, (206) 987-2105
William Womack, MD, (206) 987-2164
David Fisher, MD, medical director, (206) 987-2005
Georganna Biggins, Medical Staff Services, (206) 987-5216

Do the Write Thing

The Washington State Legislature amended the Pharmacy Act in 2006 to require that all prescriptions be either hand-printed, typewritten or electronically generated.

Even if a prescription written in cursive handwriting seems perfectly readable, it is not considered legible, and pharmacists are required to reject it and contact the prescribing physician for a legible prescription.

The Children’s pharmacy still sees prescriptions written in cursive, so a campaign is underway to remind physicians of the law, and to remind them to hand print or electronically generate all prescriptions.

Flyers have been posted in team rooms at the hospital, and Dr. Mark Del Beccaro, pediatrician-in-chief, will contact physicians who repeatedly use cursive on prescriptions, to remind them of the requirements for a legible, legal prescription.

A similar campaign is underway to remind prescribers not to use dangerous abbreviations such as “qd.” When in doubt, write it out!

Children's to Launch Sports Medicine Program

Children’s is launching a comprehensive Sports Medicine program in Seattle and Bellevue this fall. This program will build on current sports medicine services offered by the Department of Orthopedics.

Specialists from Orthopedics, Rehabilitation Medicine and Adolescent Medicine will provide a full range of care that addresses the ongoing needs of developing athletes. Services will include physical therapy, nutrition and injury prevention advice, and all of the current orthopedic surgical and nonsurgical services.

Sports medicine specialists Dr. Tom Jinguji and Dr. Greg Schmale and physician assistant Cheryl Parker, PA-C, already see patients in Seattle and Bellevue. They will be joined in the fall by Dr. Cora Colette Breuner from Adolescent Medicine and Dr. Brian Krabak, a new Rehabilitation Medicine physician.

To refer a patient to a Children’s sports medicine specialist, call (206) 987-2080 or fax in a new appointment request form (NARF) to (206) 985-3121.

Adolescents with Depression Needed for Study

Adolescents with depression are being recruited for a research study on a new type of “talk” therapy called behavioral activation therapy.

Participants will receive 12 weeks of free treatment in this clinical trial and participate in evaluations during treatment and the nine-month follow-up period.

Dr. Elizabeth McCauley and Dr. Kelly Schloredt, from Children’s Department of Psychiatry and Behavioral Medicine, will conduct this study.

The study seeks to increase treatment options and improve outcomes for depressed adolescents. Study participants will be selected at random to receive one of three treatments: individual behavioral activation therapy, family-based behavioral activation therapy, or the standard outpatient care provided at Children’s, which involves therapy and could also include medications.

McCauley and Schloredt will compare outcomes through the treatment and during the follow-up period.

To participate, adolescents must be between the ages of 11 and 18, and must not have any major medical conditions. Participants may be taking antidepressant medications concurrently.

For more information about the study, contact Schloredt at (206) 987-4457. To refer an adolescent for possible participation, contact Abby Davis, research assistant, at (206) 987-1439.

Wallace Receives NIH Grant for Arthritis Study

Dr. Carol Wallace, an attending physician at Children’s and UW professor of pediatrics, recently received a four-year grant from the National Institute of Arthritis, Musculoskeletal and Skin Diseases to conduct a clinical trial of aggressive therapy for children with polyarticular arthritis.

This is the first NIH grant in more than 20 years for a clinical trial for childhood arthritis. Researchers will work with 86 children at 15 pediatric rheumatology centers across the country. Remission of the disease is the treatment goal.

“We are excited about the potential impact of this study because childhood arthritis occurs in three out of 1,000 children — half of whom continue to suffer from arthritis as adults,” says Wallace.

Eddy to Study Kidney Dysfunction in Uganda

Dr. Allison Eddy, division chief of Nephrology at Children’s, and attending nephrologist Dr. Sangeeta Hingorani recently received funding for a pilot project entitled “Impact of Kidney Dysfunction on Mortality Rates in Ugandan Children Hospitalized with Acute Infections.”

The funding is from the Puget Sound Partners for Global Health, a partnership that includes the Bill & Melinda Gates Foundation, the University of Washington School of Medicine, the Fred Hutchinson Cancer Research Center, and others.

“A trip to work with the only pediatric nephrologist in east Africa last summer motivated this grant application,” Eddy says. “The mortality rate for children admitted to the main medical referral center in Uganda with severe infections is still 5% to 17%. Due to limited resources, kidney function is not even evaluated in most of these children as it would be here. I’m delighted to have the opportunity to collaborate with Mulago Hospital as we seek to identify preventable causes of death in this group of pediatric patients.”

Faculty Improves Communication with Community Providers

Thank you to the many referring providers who have submitted compliments to Physician Relations about Children’s physicians’ prompt replies to their phone calls. In May, Children’s physicians responded to 91.5% of urgent calls within the standard of 15 minutes and 96.2% of nonurgent calls by the end of the day. Faculty may also use the physician operator at (206) 987-7777 to call referring physicians and other Children’s providers.

Geyer Receives Mentoring Award

Dr. Russ Geyer, clinical director of Hematology/Oncology at Children’s, received the new Department of Pediatrics Faculty Mentor Award.

Geyer was described as a thoughtful and compassionate physician who inspires by example. He was also praised by those nominating him for providing guidance in their clinical oncology research and for encouraging them to apply their findings to improve patient care.

“Russ is the perfect choice for the very first Faculty Mentor Award,” says Dr. Bruder Stapleton, chief academic officer. “His clinical skills, medical knowledge and humanistic values are truly inspirational.”

Children's Faculty Recognized

Dr. John Neff, Dr. Chris Delecki, Dr. Luke Hoffman, Dr. Denise Shushan, Dr. David Loren and Dr. Linda Quan have been honored recently.

Dr. John Neff, director of the Center for Children with Special Needs, was recently honored for his work as the chair of the Health Coalition for Children and Youth (HCCY). Children’s Alliance, a nonprofit organization, recognized Neff for his leadership in HCCY’s efforts to ensure health-care coverage for all children in Washington state.
Dr. Chris Delecki, dental director of Odessa Brown Children’s Clinic, was appointed president-elect of the Seattle/King County Dental Society, which is part of the American Dental Association.
Dr. Luke Hoffman, attending physician in the Pulmonary Division, received an Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) Young Investigator Award from the American Society for Microbiology.
Dr. Denise Shushan and Dr. David Loren were also honored recently with Faculty Teaching Awards.
Dr. Linda Quan received the Stanley Stamm Role Model Award.

Faculty Members Promoted

Children’s congratulates the following faculty members who were promoted at the University of Washington School of Medicine as of July 1:

Gregory Schmale, MD, associate professor, Orthopedics
Joseph Siebert, PhD, professor, Pathology
Harris Baden, MD, associate professor, Pediatrics
Paul Carpenter, MD, associate professor, Pediatrics
Dimitri Christakis, MD, MPH, professor, Pediatrics
Beth Ebel, MD, MSc, MPH, associate professor, Pediatrics
Ian Glass, MD, MB, ChB, associate professor, Pediatrics
Troy Johnston, MD, associate professor, Pediatrics
Charlotte Lewis, MD, associate professor, Pediatrics
Heather McPhillips, MD, MPH, associate professor, Pediatrics
Carol Miao, PhD, research associate professor, Pediatrics
Karen Murray, MD, professor, Pediatrics
Catherine Pihoker, MD, professor, Pediatrics
Laura Richardson, MD, associate professor, Pediatrics
James Stout, MD, professor, Pediatrics
Carol Wallace, MD, professor, Pediatrics

Transcribed Reports Faxed Automatically

Starting in July, you will automatically receive notes for your patients by fax if Children’s has your fax number on file.

This automatic fax system will replace the old process of sending printed copies by mail. Notes will now be sent to both the patient’s primary care provider (PCP) and referring physician, if applicable. They will include clinic visit and consultation notes, interim and discharge summaries, operative reports and several diagnostic studies.

If you receive a fax about a patient who is not being seen in your practice, please fax it back to Transcription Services using the fax number provided on the cover sheet.

Please note that your practice may receive multiple copies of the note if the PCP and referring physicians are different, but are both in your practice. This might also occur if the practice itself is listed as the PCP (as in community clinics) and the referring physician is listed individually. Children’s system is unable to differentiate among physicians based on practice name.

For questions, contact Paula Dascher, Transcription Services manager, at (206) 987-2076.

Bladder Exstrophy Conference

Children’s and the Association for the Bladder Exstrophy Community are sponsoring the third international “ABC Conference for Families Living with Exstrophy/Epispadias and Hypospadias” Aug. 10 to 12 at Children’s. For more information or to register, visit the ABC Web site or contact Ginger Thomas, RN, Children’s exstrophy nurse, at (206) 987-1158.

Mariners Tickets Available for Children's Providers

Help Children’s celebrate its 100th birthday at Safeco Field on July 28. You can purchase an unlimited number of discounted tickets for Children’s staff and medical staff for $10 in the Volunteer Office at Children’s or use the order form.

New Medical Staff and Allied Health Professionals

Children’s welcomes these new medical staff members:

Daniel K. Low, MB BS, Anesthesia, Children’s
Brenda W.S. Eng, ARNP, Orthopedics, Children’s
Henry S. Chang, MD, MS, Puget Sound Otolaryngology
Shawn E. Rogers, MD, Puget Sound Otolaryngology
Jonathan M. Whitfield, MB ChB, Neonatology, UW

UW Leadership Training for Physicians and Clinical Professionals

The University of Washington offers a Certificate Program in Medical Management (CPMM) to help physicians and other clinicians acquire practical business and management skills to enhance their effectiveness in everyday work situations and prepare them for leadership positions. The 2007-08 program begins with the course “Medical Practice Quality Measurement and Management,” held on Wednesday evenings from 5:30 to 8:30 starting Sept. 26. For more information, contact Bree Rydlun at (206) 616-2947 or brydlun@u.washington.edu, or visit the CPMM Web site.

Grand Rounds

View the schedule of upcoming Grand Rounds.

Grand Rounds Online

View online versions of recent Grand Rounds.

On-Call Schedule

The on-call schedule for inpatient services can be found in the secure area of the Medical Staff Web site. It is updated on a daily basis.