Notes Progress New VP Position Targets Quality In this issue

Progress Notes
Summer 2013
A publication of the Medical Staff of Children’s Hospital Central California
In this issue
Improving Patient Care
Patient Safety Rounds
Melody Valve
New Pediatric Housestaff
New VP Position Targets Quality
It goes without saying that the highest quality of care for our patients and their
safety is paramount to our mission. Our low rates of hospital-acquired infections and medication errors continue to demonstrate the outstanding efforts of
our physicians and staff to keep patients free from preventable harm.
Todd Suntrapak
In this era of healthcare reform,
it’s imperative that Children’s
Hospital continues its focus
on quality improvement. While we’ve made
great strides toward our goal of achieving – and
sustaining – zero incidents of patient harm,
there’s more work to be done.
President and
Chief Executive Officer
So, to that end, as we look to strengthen our longstanding commitment to the highest quality of
care for our patients and their families, and as we
position our organization for continued success
in the new healthcare environment, we’ve developed and are actively recruiting for a new leadership position: Vice President, Quality.
Medical Staff Officers
Timothy Hansen, MD
Chief of Staff
Sahar Barayan, MD
Vice Chief of Staff
Gary Magram, MD
Secretary / Treasurer
Reporting to the Chief Medical Officer, the
VP Quality will provide oversight, planning
and direction for all clinical quality and performance improvement programs in accordance with the Hospital’s strategic plan. Specifically, the
VP Quality will be responsible for developing an organizational quality plan that will improve
patient outcomes, patient satisfaction and patient safety, including developing standardization,
improving efficiency and adjusting workflows to enhance system performance.
We’re looking for an innovative leader who brings strong clinical experience and an excellent
track record of advancing quality; someone who will play an integral role in quality and outcomes
strategy development and implementation, as well as work with many different constituencies
both internally and externally and on a national, state, regional and local level.
We hope to have this new executive team member on board by fiscal year-end and we are excited
to see how this role will complement an already outstanding team.
Thank you for your support and active participation, and I look forward to sharing an update with
you soon.
Department Chairs
Anesthesia & Critical Care Medicine
Adam Holmes, MD, Chair
Marty Clayman, MD, Vice Chair
Tim Hansen, MD
Chief of Staff
Cardiology & Cardiothoracic Surgery
Narakesari Heragu MD, Chair
Valeriano Simbre, MD, Vice Chair
Emergency Medicine
Robert Kezirian, MD, Chair
Henry Pollack, MD, Vice Chair
Medical Imaging
Fred Laningham, MD, Chair
Michael Myracle, MD, Vice Chair
John Kinnison, MD, Chair
Wendy Tcheng, MD, Vice Chair
Pathology & Laboratory Medicine
Stephen Kassel, MD, Chair
Aleli Siongco, MD, Vice Chair
Michael Dunham, MD, Chair
Mimi Chao, MD, Vice Chair
Committee Chairs
Medical Executive Committee
Timothy Hansen, MD
Committee on Interdisciplinary Practices
Peter Nakaguchi, MD
Credentials Committee
Carl Owada, MD
Health Information Management
Joel Brownell, MD
Human Subjects Committee (IRB)
Stephen Kassel, MD
Institutional Ethics Committee
Armando Fuentes, MD
Joint Performance Improvement
Sahar Barayan, MD, Chair
J. Charles Smith, MD
Medical Staff
Education Committee Co-Chairs
Ana Lia Graciano, MD
Robert Kezirian, MD
Medical Staff Well-Being
John Sanchez, MD
Patient Safety Committee
Samuel Lehman, MD
Pharmacy, Therapeutics & Utilization
Stephen Kassel, MD
Professional Review Committee
Timothy Hansen, MD
Quality Council
Stephen Kassel, MD
Committee Reporting to the Department
of Surgery: Trauma Committee
Michael Allshouse, DO, Chair
Improving Patient Care
A Continuous Process
This publication is known as Progress Notes. At some point in our medical education
we started writing progress notes as we rotated through the various services as medical
students. I wrote my first progress note while on the general surgery service. I recall those
notes being about a quarter to half-page in length. My next month was with the orthopaedic
service at the VA, and one of the comments I received about those notes was that they were
much too long. My supervising resident said to me with his Tennessee accent, “I ain’t no
medical doctor! So don’t put all that extra junk in there.” When I began my internal medicine rotation my supervising intern told me that I needed to add “much more information”
in my progress notes.
Needless to say, as a medical student, I was quite confused as to what constituted proper
documentation of the care I provided. That was before I had any exposure to peer review,
quality of care or the concept of performance improvement.
Evaluation of the care physicians provide has gone through many different stages. What
used to be considered “acceptable outcomes,” “acceptable complication rates,” or “That’s just
the way it is,” is now being looked at very carefully and questioned. “How can we improve
care?” “How are others finding ways to improve care?”
The medical staff is in the process of reorganizing the way we perform peer review. We are
preparing a system that has multispecialty representation, and is consistent, timely, educational and positive. We believe that physicians are inherently interested in learning how to
continually improve the care we provide our patients. Our goal is to develop a process that
emphasizes self-improvement, learning from our collective experiences and working to
advance systems.
You will notice in this edition of Progress Notes that we continually work to improve
patient care here. Todd Suntrapak describes the role of the new quality officer, Sam Lehman
describes the success of our Executive Patient Safety Rounds and Joel Brownell writes about
the goal of enhanced patient care through electronic tools and processes. Our Willson Heart
Center broke new ground with the Melody Valve. We also welcome the new housestaff who
will be writing their own “Progress Notes.”
Samuel Lehman, MD
Medical Director, Patient Safety
Pediatric Intensivist
Executive Patient Safety Rounds
We have many improvement projects in
our patient safety program. Some of these
programs target reducing a specific type of
harm such as our CLABSI program. Other
initiatives focus on improving our patient
safety culture. This culture is an attribute that
is hard to define in a healthcare organization.
I like to think of it as how we, both individually and collectively, prioritize the safety of
our patients. While most people and regulatory bodies think of harm-specific initiatives,
perhaps the most important work our organization can do is develop a culture of safety.
Having an environment where people put
patient safety above all else makes the rest of
the work easy.
Six years ago when I assumed the role of
patient safety officer at Children’s, I brought a
program entitled the Executive Patient Safety
Walk Rounds from the Institute of Healthcare
Improvement. The primary goal of this initiative is to improve our patient safety at all
We bring our most senior executives face to
face in small groups with our frontline staff to
identify patient safety issues. Each month we
visit an inpatient or outpatient area at Children’s. We meet with nurses, doctors, respiratory care practitioners, therapists, health
unit coordinators, etc., and ask them their
• Have they seen an error or a near miss?
• Have they seen a patient harmed?
• What about our systems – do they help us
prevent mistakes?
At the end of our discussion we meet with the
manager or director of that area and develop
action plans for the items we identified.
Since launching our Executive Patient
Safety Walk Rounds in 2007, we have
logged over 800 safety concerns in
our database and implemented over
600 action plans related to these
items. Key accomplishments range
from the pharmacy and patient
care division collaborating to adjust
standardized scheduled medication administration times to ensure
enough time for patient assessment
and on-time medication administration, to surgeons and patient care
administration working together to open
additional postoperative beds on Voyager to
provide postsurgical nursing care.
The real benefit, however, is the opportunity
for the Hospital’s most senior leadership to
interact with the frontline staff taking care of
patients. This allows leadership to learn about
patient safety concerns firsthand and brings
focus to the patient safety program.
Equally important is that our frontline clinical
staff also have the opportunity to witness
firsthand the significant value that our senior
leadership places on keeping patients safe from
medical error.
Get Involved
Have you seen a patient safety
concern? Does something keep
you up at night worrying about
how harm might come to one of
your patients by medical error?
You don’t have to wait until the
Executive Patient Safety Rounds.
You can email your concern and
we will add it to our register:
Dr. Lehman, Medical Director,
Patient Safety:
[email protected]
Melissa Rhoads,
Patient Safety Program Manager:
[email protected]
New Medical Staff
Members include:
Pediatric Cardiology
David Rosenthal, MD
Dr. Rosenthal practices at Lucile Packard Children’s Hospital as a pediatric cardiologist and
sees patients in our pediatric cardiology clinic
Education & Training: Albert Einstein College
of Medicine at Yeshiva University in New York
Residency: Columbia University College of
Physicians and Surgeons
Dr. Rosenthal completed a fellowship at
Yale-New Haven Hospital in Connecticut in
pediatric cardiology.
Pediatric Critical Care
Azadeh Fayazi, MD
Dr. Fayazi is a new member of Pediatric
Anesthesia Associates Medical Group
(PAAMG) practicing as a pediatric intensivist
Education & Training: Wright State University
School of Medicine in Ohio
Residency: Virginia Commonwealth University
Dr. Fayazi completed a fellowship at Virginia
Commonwealth University in pediatric
critical care.
Family Practice
Michael Bohlman, MD
Dr. Bohlman practices at Madera Family
and Pediatrics Medical Group as a family
practice physician
Education & Training: Loma Linda University
Medical Center
Residency: Mercy Medical Center
Maternal Fetal Medicine
Elizabeth Platz, MD
Dr. Platz is a new member of Specialty
Medical Group practicing as a perinatologist
Education & Training: Medical University of
South Carolina
Residency: Medical University of
South Carolina
Dr. Platz completed a fellowship at Medical
University of South Carolina in maternal
fetal medicine.
Pediatric Otolaryngology (ENT)
James Barrese, MD
Dr. Barrese is a new member of Specialty
Medical Group practicing as a pediatric
Education & Training: University of Illinois
College of Medicine
Residency: Los Angeles County+USC Medical
Dr. Barrese completed a fellowship at Boston
Children’s Hospital in pediatric otolaryngology.
Lisa Hills, MD
Dr. Hills is a new pediatrician practicing at
Fresno Children’s Medical Group
Education & Training: American University
of the Caribbean
Residency: Florida State University
Joel Brownell, MD
Chief Medical
Information Officer
Over the past few years we implemented a
significant upgrade to our electronic medical
record and transitioned some of our most
basic activities away from paper, including
electronic prescriptions, physician orders,
physician documentation, nursing documentation, ancillary staff documentation,
etc. In the fall we will implement Athena in
the ambulatory space – one of the last major
steps toward transitioning from a paperbased practice to a contemporary EMR both
in the hospital and clinic settings. From that
perspective, the game is nearly over! The
reality is that we are much closer to half-time
than the seventh-inning stretch as it relates to
patient care.
These electronic tools and processes were
never really the goal in and of themselves.
The goal, of course, is improved and more
cost-effective patient care. It’s not difficult to
understand that a paper-based world would
never provide us the tools we need to reach
our goal, but simply implementing electronic
tools is not enough. The roadmap that makes
up Meaningful Use calls out this transition
clearly. We recently completed our 90-day
period attesting for Stage 1 Meaningful Use
by demonstrating our use of some basic electronic tools and doing minimal testing of
data exchange. Nationwide, the healthcare
industry will be pushed toward meeting objectives associated with Stage 2 Meaningful Use,
which focuses more on improved use of these
basic tools as well as a much more robust
exchange of information between healthcare
organizations and the patients we serve.
The real goal of being able to demonstrate
improved outcomes and cost-effectiveness is
part of Stage 3, which we anticipate achieving
in several years. A long process indeed…
So, as we gear up for another round of disruptive innovation transitioning to our ambulatory EMR, let’s try to pace ourselves in
meeting our short- and long-term priorities.
It’s important that we balance caring for our
patients – as well as taking care of ourselves –
with investing the time and energy necessary
to progress toward the long-term transformational changes in healthcare so desperately
Keep up the good work!
Radiation Reduction
Children’s Hospital offers new computed tomography (CT) technology that cuts patients’ radiation exposure by half. Children’s 64-slice CT scanner with the new adaptive statistical iterative
reconstruction (ASIR) software-based technology delivers high-speed, high-quality images with 25
percent to 50 percent less radiation. The decrease is based on the type of procedure the child undergoes. The Hospital’s 16-slice CT scanner already utilizes the dose-reduction software.
“This technology enables us to significantly reduce radiation levels on our fastest CT scanner and
administer just the dose required to achieve quality images,” said Elsa Ozuna-Richards, director,
diagnostic imaging services, Children’s Hospital. “This is especially important for our kids who may
need multiple imaging tests, such as cancer patients.”
Monica Prinzing
Senior Writer,
Communications and Marketing
Children’s Hospital Central California
Melody Valve Comes to the Valley
Pioneering new ground, Children’s Hospital successfully performed the first heart valve replacements in
the Valley without cracking open the chest.
Dr. Paolo Aquino, a pediatric cardiac interventionist,
led the Children’s team that implanted Melody Transcatheter Pulmonary Valves in two teenage boys on
July 1. Both went home the next day after undergoing a
four-hour procedure.
“I’m looking forward to having more energy!” said
Devon Robinson, 13, of Fresno excitedly while
preparing for discharge. The other Melody valve
patient is 17 years old from Porterville.
Many children with congenital heart disease are born
with a dysfunctional or nonexistent pulmonary valve.
Surgery may be necessary to insert a conduit or tube
to substitute the faulty pulmonary valve. As the child
grows these artificial conduits need to be replaced
over time, resulting in multiple open-heart surgeries.
The new Melody transcatheter pulmonary valve is used
to repair a blocked or leaky artificial pulmonary valve
previously inserted to correct the patient’s congenital
heart defects. The Melody valve is implanted into the
heart through a catheter inserted inside a vein in the
patient’s leg during a heart catheterization. Composed
of processed tissue, the Melody valve is sewn inside a
wire stent and crimped onto an angioplasty balloon
on the end of the catheter. Using X-ray, the valve, wire
stent and balloon assembly is directed into the heart.
The balloon is inflated to deploy the valve. After the
assembly is removed, a Band-Aid is placed over the
entry site. “Replacing a heart valve without major
surgery is an important breakthrough in preserving
our patients’ health and ensuring the best quality of
life,” said Dr. Aquino.
The Melody valve may delay the time until patients
require surgery, hopefully decreasing the number of
open-heart surgeries over a lifetime. “This should last
Devon for many years,” said Dr. Aquino.
That’s good news to Devon who has had many heart
procedures since he was a baby. Diagnosed with
tetralogy of Fallot, pulmonary atresia, and multiple
aortopulmonary collaterals, Devon underwent his
first open-heart valve surgery at 5 months old, and
again at 2 and 6 years old to replace it. When Devon’s
valve recently became narrowed and leaky, Children’s
cardiac specialists offered the new Melody valve as an
alternative to surgery.
The U.S. Food and Drug Administration approved the
Melody valve in 2010. Children’s is the first hospital in
the region authorized to use it in patients. Children’s
pediatric cardiac team has long been known for its
expertise. A decade after conducting its first pediatric open-heart surgery in 1958 on a 9-year-old girl,
Children’s reportedly performed the first open-heart
surgery with an artificial valve on the youngest person
in the world, a 5-month-old girl.
Today, the Willson Heart Center at Children’s actively
follows over 200 patients who eventually will need
their pulmonary valves replaced. “The Melody valve is
very promising for many of our patients but it’s not for
every patient,” said Dr. Carl Owada, medical director,
catheterization lab. “This is a game-changer in the
management of congenital heart disease.”
“Dr. Aquino is my favorite doctor!” exclaims Devon
Robinson, 13, the day after undergoing the Melody Valve
Robert Kezirian, MD
Pediatric Emergency Medicine
UCSF-Fresno Pediatric
Program Director
A Lifelong Journey of Learning
Education is the great equalizer of the conditions of mankind, the balance-wheel of nature’s abuses and barriers for
health and functional wellbeing. Every medical student, resident and subspecialist in training or physician in practice
must be encouraged to get as much education as they have the ability to take. We want this not only for the patient’s
sake, but also for the practitioner’s sake. What can be more edifying or more seasonable than learning and the healthcare of children, each leaning on the other for their mutual and surest support! Medicine and education are devoted
This summer, our new pediatric housestaff continues in their lifelong journey of learning. Please welcome them and
support their educational quest in being the best pediatricians.
Janae Barker, DO
Touro University
Dr. Barker completed her medical training at Touro University College of Osteopathic Medicine at
Vallejo, Calif., in June. While at Touro, she received the Pediatric Distinguished Student Award and
Student Doctor of the Year Nominee. She received her B.A. degree in biology from UC Santa Barbara.
Dr. Barker has volunteered for many programs, including Doctors Without Walls and Women’s Free
Shelter Clinic.
Anita Chadha, MD
Ross University
Dr. Chadha graduated in March with her medical degree from Ross University. She received her B.A.
degree in molecular and cellular biology from UC Berkeley. Dr. Chadha was a volunteer for Physicians for Human Rights in Portsmouth, Dominica, where she provided information and awareness on
women’s healthcare.
Albert Chow, MD
Medical College of Wisconsin
Dr. Chow received his medical degree in May from the Medical College of Wisconsin. He received his
B.S. degree in biology at University of Michigan Ann Arbor. While in medical school, Dr. Chow was a
member of the Asian Pacific American Medical Student Association, which organized activities such as
the Hmong Health Education Program and the first medical student-driven Community Health Fair.
Anna Ekstrom, DO
Touro University
Dr. Ekstrom received her medical degree from Touro University College of Osteopathic Medicine in
Vallejo, Calif. She received her B.S. degree in biochemistry from UC Davis, and her MPH from Touro
University. Anna was a volunteer for the Suitcase Clinic at Berkeley, which offered free health and
social services to the homeless and to a women’s shelter. She also taught science to elementary school
Erica Gastelum, MD
University of California, San Francisco
Dr. Gastelum received her medical degree from the University of California San Francisco in June. She
completed her B.S. degree in neuroscience from University of California Los Angeles. Dr. Gastelum has
been involved in many activities, including being the founding chair of INTERAXON, a program geared
toward underserved inner-city schools in the Los Angeles area, to foster interest, excitement and curiosity about the brain among K-12 students.
Jessica Lee, MD
Ross University
Dr. Lee graduated in May with her medical degree from Ross University. She received her B.A. degree in
public health and her M.H.S in environmental health sciences from Johns Hopkins University. She has many
interests, including being a volunteer in Dominica for the Salybia Mission Project, where she directed and
organized three health clinics per year.
Mitul Patel, MD
Ross University
Dr. Patel received his medical degree from Ross University. He received his B.S. degree in human biology
from UC San Diego. Dr. Patel has been involved in many volunteer activities and is the creator/director
of the first Asha for Education Fashion Show (San Diego California Chapter), which has now become an
annual charity event that creates awareness and raises funds for education of children in India.
Elaine Peterson, DO
Pacific Northwestern University of Health Sciences College of Osteopathic Medicine
Dr. Peterson received her medical degree in May from Pacific Northwestern University of Health
Sciences College of Osteopathic Medicine. She received her B.S. degree in biochemistry from Western
Washington University. Dr. Peterson has volunteered with Humanity For Children, Nick of Time Foundation, and Child and Family International.
Sonia Solomon, DO
Philadelphia College of Osteopathic Medicine
Dr. Solomon graduated in June with her medical degree from Philadelphia College of Osteopathic Medicine. She received her B.S. degree in biology from the Widener University in Philadelphia. Dr. Solomon was
a volunteer for Maximo Nivel in Costa Rica, where she volunteered at an AIDS/HIV clinic and conducted
physical examinations and assisted in organizing preventative medicine seminars.
Jasmine Turner, MD
Loma Linda University
Dr. Turner received her medical degree from Loma Linda University in May. She received her B.S.
degree in biomedical sciences from Oakwood University in Huntsville, Ala. Dr. Turner has volunteered in many areas, including as community service coordinator for an OB-GYN interest group that
promoted women’s health.
Alicia Walker, DO
Touro University
Dr. Walker received her medical degree from Touro University in Vallejo, Calif. She received her B.A.
degree in chemistry from California State University, Fresno. Dr. Walker was a volunteer at Valley Children’s Hospital in Fresno before going to medical school. She was also an academic research associate
at University Medical Center.
Monica Zlotnicki, MD
St. George’s University
Dr. Zlotnicki completed her medical training in May at St. George’s University in Grenada. She
received her B.S. degree in microbial biology at UC Berkeley. Dr. Zlotnicki was a student volunteer
researcher for the United States Department of Agriculture in Alameda and assisted in the research
of analyzing the molecular regulation of the milkweed pod 1 gene in maize and its subsequent effects
on organ morphology.
9300 Valley Children’s Place
Madera, CA 93636-8762
Save the Date - Medical Staff Dinner
The Medical Staff of Children’s Hospital invites you and a guest to join your colleagues for an
evening of socializing and recognition of Children’s many dedicated physicians:
Tuesday, Sept. 24, 2013, 6:30 p.m. - 9 p.m.
Copper River Country Club, 11500 N. Friant Road, Fresno
Hors d’oeuvres will be provided. Two drink tickets provided per person.
Please RSVP to (559) 353-6115
Dr. Watts Receives ‘Heroes’ Award
Dr. Gregory Watts, a pediatric emergency medicine physician, was nominated and selected for
one of the 2012 “Heroes in HealthCare” awards by Business Street Online. Dr. Watts was awarded
in the physician category for his tireless work to improve healthcare in our community.
Dr. Watts, congratulations on your honor!
PICU Wins the Gold
The Pediatric Intensive Care Unit (PICU) at Children’s Hospital Central California
earned the Beacon Award for Excellence from the American Association of CriticalCare Nurses (AACN). Less than a dozen PICUs nationwide and only three PICUs in
California have received this designation. Children’s received gold – the highest level
of success – demonstrating sustained excellence in unit performance and patient
outcomes. Children’s was first recognized with the honor in 2010.
Medical Staff Services
(559) 353-6115
Children’s Hospital Medical
Staff Services solicits articles
for Progress Notes several
times a year. It’s a great
place to distribute news,
share accomplishments, and
communicate with all members
of our medical staff. Contact us
for information or to make
a submission.