SUTURES Cedars-Sinai Medical Center Department of Surgery Edition: October 29, 2010 In This Issue:
Pharmacy Update Patient Classification and Surgery (Procedure) Scheduling Citizenship and Beyond
PHARMACY UPDATE Furosemide, Bumetanide, Torsemide, Oh my!
As some of you may remember, torsemide (Demadex®) injection was discontinued in 2007 by Roche®. However, a generic company has recently started manufacturing this product again and we are now able to purchase and dispense the medication. Since intravenous furosemide is still not available (we currently have an automatic substitution from furosemide IV to bumetanide IV) and bumetanide availability is not consistent, we are hoping that torsemide injection can provide a reasonable therapeutic option for some patients. Please consider using torsemide injection whenever possible. The conversion between the three intravenous loop diuretics is: Bumetanide 1mg IV=Furosemide 40mg IV=Torsemide 20mg IV. Oral formulations of furosemide, bumetanide, and torsemide continue to be available. Epinephrine 0.1mg/ml 10ml syringes-AVAILABILITY UPDATE
We are happy to inform you that epinephrine 0.1mg/ml 10ml syringes are available from the manufacturer! We are now in the process of purchasing and stocking all new code blue trays with the epinephrine 0.1mg/ml 10ml syringes instead of the epinephrine 1mg/ml 1ml concentrated ampules. Please note that although all new code blue trays will have the epinephrine syringes, some already prepared code blue trays may still contain the epinephrine concentrated ampules.
PATIENT CLASSIFICATION AND SURGERY (PROCEDURE) SCHEDULING
In August 2010, Cedars Sinai instituted new processes and procedures with new clinical resources aimed at improving patient classification of our surgery and procedure patients.
Patient classification is a significant compliance issue for Medicare as well as MediCal and other insurance carriers. Over the past year, various governmental audit agencies have focused on the hospital community and this topic of patient classification. Hospitals are at great risk if found to be non-compliant with their regulations. In response to this ongoing oversight, Cedars Sinai has taken steps to further improve the proper identification of patient class. Ultimately, patients are classified as Inpatients or Outpatients for the purposes of billing and reporting. Within that overriding structure, procedure patients are scheduled as either “AM Admits” which is considered inpatient; “In-house” which is considered inpatient; or “outpatient procedure” which is outpatient in SIS and CSLink. As of the beginning of August, the option of “23 hour” was removed as it was not a true patient classification and confusing to users. Moreover, patients cannot be scheduled as ‘observation’ but may become so after a procedure if they need to be evaluated for potential inpatient admission and with an appropriate physician order. Case management has instituted a pre-review AND post-review of all scheduled procedures for the appropriate assignment of patient class. Additionally, specific ‘patient classification department guides’ were developed for non-OR procedural areas like the cath lab, interventional radiology and GI labs. Case managers are always available to assist with the proper determination of patient class. Please note, the distinction of patient class is very important to hospital compliance but does not change the care you need and desire to provide your patients. We appreciate your ongoing support of our endeavors in this area and welcome feedback on how we can further improve our process making it smoother for you and your patients.
CITIZENSHIP AND BEYOND Calendar VASCULAR DAY Wednesday, November 3, 2010 from 7:00am – 1:00pm The Sanford Rosenbaum Lectureship in Vascular Surgery with Dr. Michael Conte 7:00 am: Surgery Grant Rounds - "Critical Limb Ischemia: an Evidence Based
Approach to Limb Salvage in 2010?" in Harvey Morse 1-3
9:30 am: Matrix Conference in Harvey Morse Auditorium 10:30 am: Vascular Case Conference in Harvey Morse Auditorium 11:30 am: Break 12:00 pm: Medicine/Surgery Grand Rounds - "Turning Veins into Arteries: What Have
we Learned about Vein Graft Disease?" in Harvey Morse Auditorium
_ Surgery Grand Rounds Wednesday, November 10 at 7:00 am in Harvey Morse 1-3 “Fundamentals of Aortic Surgery” with Ali Khoynezhad, MD Publications and Presentations
V. Krishnan Ramanujan, Songyang Ren, Songyong Park, and Daniel L Farkas, (2010) Non-invasive, Contrast-enhanced Spectral Imaging of Breast Cancer Signatures in Preclinical Animal Models In Vivo.J Cell Sci Therapy 1:102. doi:10.4172/2157- 7013. 1000102 Arkadiusz Gertych, Daniel L. Farkas, and Jian Tajbakhsh, (2010) Measuring topology of low-intensity DNA methylation sites for high-throughput assessment of epigenetic drug-induced effects in cancer cells.Exp Cell Res. 2010 Nov 15;316(19):3150-60. Philip K. Frykman, MD, PhD recently returned from the XXIII International Symposium on Paediatric Surgical Research (ISPSR) annual congress in Tokyo, Japan on September 12th – September 14th where he gave an oral presentation and a poster presentation. The oral presentation was given on September 13th, titled "Do Primary Immune Abnormalities Contribute to Hirschsprung-Associated Enterocolitis?" The authors on the presentation were: Philip K. Frykman, Zhi Cheng, Lifu Zhao, Deepti Dhall, Xiao Wang, Catherine Bresee. The poster presentation was given September 14th, titled "Preliminary Evaluation of a New Compact High-Definition Video Microscope for Pediatric Surgery: Is it Time to Throw Away the Loupes?" The authors on the presentation were: Philip K. Frykman, Andrew Freedman, Barry Duel, A. Trofimenko, George Berci. Dr. Frykman presented a Special Lecture: Graduate Student Course in Medicine, on September 15th at Jichi Medical University, Shimotsuke, Tochigi, Japan titled “Does the Neural Crest Play a Role in Immune System Development? New Insights from Hirschsprung Associated Enterocolitis”. Acknowledgements The Department of Surgery Congratulates Jian Tajbakhsh, PhD, Assistant Professor of Surgery and head of the Translational Cytomics Group (TCG). His grant titled "Prostate Cancer DNA Methylation Profiling by Advanced 3-D Imaging ", in conjunction with the
Louis Warshaw Prostate Cancer Center (CSMC) was funded in the amount of $725,138 by mechanisms supported by Congressionally Directed Medical Research Programs (CDMRP)-Prostate Cancer Idea Development Award. The Department of Surgery Congratulates Eric Ley, MD. His project titled “Utilize previous experience with murine model for TBI to determine the effect of beta blockade on TBI related cerebral perfusion, ischemia and immune dystfunction.” was funded in the amount of $50,000 by the American Assocatiation for the Surgery of Trauma. Dr. Shirin Towfigh, MD, Director of Medical Student Education in the Department of Surgery would like to acknowledge Dr. Marko Bukur, for teaching our interns Ventilator Management" during Skills Lab, Sept 2, 2010.
Items for submission to Sutures may be sent to Meg Jenkins at The next SUTURES will be Wednesday, November 10, 2010.
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