Boost the pace

A quick look at TRP awards

More information to come

Rewards Program pays for ideas thattransform health care delivery

intra-arterialthrombolysis 4

Transforming Wound Care 6

2 F O C U S J u l y 3 0 , 2 0 0 9

Timothy J. Gardner, M.D., reflects on year as AHA president

C O N T I N U E D N E X T P A G E

For thethird

straight year,ChristianaCare hasbeen rankedone of thenation’s besthospitals.And it is oneof only 3 per-cent of U.S.hospitals tomake the list.

In its annualAmerica’sBest Hospitaledition, USNews & World Report places ChristianaCare among the top 50 facilities in twospecialties: Diabetes & EndocrineDisorders, and Digestive Disorders.

Christiana Care is the only hospital inDelaware to make the list. Only 174 ofthe more than 4,800 hospitals nation-wide evaluated this year earned thisrecognition.

Testifies to exceptional care“Receiving national recognition inthese specialties is a testimony to theexceptional care provided by our doc-tors, nurses and allied health profes-sionals,” says Bob Laskowski, M.D.,president and CEO of Christiana Care.

“To be listed three years in a rowunderscores our regional and national

reputation as apremier healthcare provider.”

“Being namedone of the top50 hospitals inthe U.S. in dia-betes anddigestive disor-ders is a reflec-tion of the hardwork, dedica-tion, teamworkand Focus onExcellence ofall our care-givers and vali-

dates that we are truly transformingcare for our patients,” says Virginia E.Collier, M.D., FACP, Hugh R. SharpJr., Chair of Medicine at ChristianaCare.

New patient-safety metricTo arrive at the list, the magazineranks hospitals on several metrics,including mortality rates, reputation,number of patients cared for, qualityof nursing care, use of advanced tech-nology and presence of a trauma cen-ter. A new metric added this year,patient safety, measures how a hospi-tal protects its patients from harm.

In the past two years, Christiana Carehas also received top rankings in Ear,Nose and Throat and Endocrinology,Digestive and Respiratory disorders.

U.S. News ranks Christiana Care among nation’s best hospitals

D R . G A R D N E R , C O N T I N U E D

Christiana Care is leading the wayin Delaware in exciting new tech-

niques for treating ischemic stroke,caused by clots that block blood flowto the brain.

The technique, called intra-arterialthrombolysis, combines clot-dissolv-ing drugs and rapidly evolvingmedical devices that help doctors

mechanicallyextract the clot,restoring bloodflow to the brainand greatlyincreasingpatients’chances forrecovery.

“It’s a combina-tion of medicineand retrievaldevices,” saysBarbara Albani,M.D.

A neurointer-ventional radiol-ogist, Dr. Albanibrought some of

these techniques with her when shecame to Christiana Care in 2007 fromthe Cleveland Clinic Foundation. Shehas continued to expand those skills,lecturing on procedures that can saveand improve patients’ lives.

‘Trying to get the word out’“These techniques have been devel-oped by doctors all over the country,”she says. “We’re trying to get the wordout because they can make a tremen-dous difference in patients’ outcomes.”

Dr. Albani led a team that removed aclot from the brain of a woman whowas rushed to the hospital with symp-toms of a severe stroke. She was para-

lyzed on one side and couldn’t under-stand speech.

“We were able to extract the clot andshe had a near complete recovery,” Dr.Albani says. “After two weeks in thehospital, she went home. She didn’tneed physical therapy.”

So far, about 20 patients at ChristianaCare have been treated with the tech-niques, with a success rate of about 30percent. Without intervention, thesepatients would have had little hope.

“If patients get to my table, they’re inextremis,” Dr. Albani says. “Thesepatients need help—and likely if theydon’t get it, they will be neurologicallydevastated or potentially expire.”

For years, clots have been treated withIV medication. In 1996, the U.S. Foodand Drug Administration approvedthe use of intravenous tissue plas-minogen activator or tPA, a super clotbuster used to treat stroke, the thirdlargest cause of death in the UnitedStates. But the drug must be adminis-tered intravenously within three hoursof a stroke.

“Many physicians are hesitant to use itbecause it can cause significant, evenlife-threatening, bleeding,” Dr. Albaninotes.

Treating clots directlyNew technologies are allowing physi-cians to treat clots directly. The Mercidevice, shaped like a corkscrew, wasthe first FDA approved mechanicaldevice for stroke. The newest is a toolknown as the Penumbra System,essentially a vacuum cleaner for thebrain that uses catheterization andsuction to remove clots.

“The penumbra is the latest device inour armamentarium against stroke,”says Dr. Albani.

Through advanced imaging, doctorscan see which parts of the brain havedied due to lack of blood flow andalso can identify the ischemic penum-bra, an injured area that can be saved.

“It is the penumbra that we look for.This finding tells us there is brain thatis not getting adequate blood supply,but is not dead yet,” Dr. Albaniexplains. “That is the area of the brainwe can save if we can get blood flowback to it in time.”

Extends window time“One of the biggest hurdles we facewith stroke care is that patients arriveat the emergency room too late,” Dr.Albani says.

The advantage of intra-arterial tech-niques are that the therapies aredirected at the offending lesion, allow-ing for fewer systemic side effects andextending the time window from threehours with IV tPA to six hours withIA. Advances in imaging technologyshould allow us more accurate defini-tion of ischemic penumbra andextension of the time window forcertain patients.

Dr. Albani led the team that madeDelaware health care history last year,completing the first endovascular coilembolization of a ruptured brainaneurysm.

Now, patients no longer need to leavethe state for treatment of this poten-tially fatal condition. The operationutilizes soft, springy woven platinumwires, which are tightly packed intothe aneurysm to cut off blood flowinto it. In time, the vessel scars aroundthe coil pack.

Neurointerventional radiologist Barbara Albani, M.D.introduces another lifesaving procedure in Delaware

Barbara Albani, M.D.

4 F O C U S J u l y 3 0 , 2 0 0 9

James Gill, M.D., co-wrote “How canprimary care cross the quality chasm?”a paper published in Annals of FamilyMedicine, 2009; 7:164-169.

Presenting

n

n

Awards

6 ● F O C U S J u l y 3 0 , 2 0 0 9

C L I N I C A L N E W S

Database provides a powerhouse of information

Adrienne Abner(right), director ofChristiana Care’sWound Care Centerand Nicholas O.Biasotto, D.O.,medical director.

Sweeping changes help Christiana CareWound Care Center improve outcomes

Christiana Care’sRiverside facility hasthe only hyperbaricoxygen therapychambers availablein New CastleCounty.

Wilmington Hospital now offersthree breakthrough devices that

improve patient safety and reducetrauma and recovery time for plasticand reconstructive surgery .

VersaJetChristiana Care is the only health caresystem in Delaware to own VersaJettechnology. This device uses high-pressure sterile saline to clean anddebride dirty or chronic non-healingwounds. Wilmington Hospital usesthe VersaJet in the Center for Cosmeticand Reconstructive Surgery; SurgicalCritical Care uses it in its trauma pro-gram.

Because it does not damage surround-ing healthy tissue, the VersaJetprecisely cleans wounds and expediteshealing and recovery time. It alsoimproves surgical efficiency andreduces operating room time.

Fractional CO2 laser

Wilmington Hospital is the first andonly hospital in Delaware to use afractional CO2 laser, also called apixel laser, for laser skin rejuvenation.

Unlike traditional lasers, which essen-tially burn off a thin top layer of skin,the fractional laser produces micro-scopic energy light cones or cylindersthat penetrate the deep dermal layersand stimulate production of collagen,the connective tissue protein thatkeeps skin plump and wrinkle free.

Minimally invasive, the fractionallaser results in fewer complicationrisks such as scarring and minimalrecovery time. Patients may return towork within 24 to 36 hours after treat-ment.

Breakthrough devices now availablefor plastic and reconstructive surgery

Harmonic Synergy deviceWilmington Hospital is also the firstand only hospital in Delaware to usethe Harmonic Synergy device forreconstructive and cosmetic surgery.

Rather than electrical conductiveenergy, the device uses mechanicalultrasonic energy that simultaneouslycuts and coagulates vessels and lym-phatic channels. The result is mini-mal thermal tissue damage and noneuromuscular stimulation—no elec-trical current passes through thepatient.

Like the fractional laser, theHarmonic Synergy device causes lesstrauma to soft tissue and improvesrecovery time.

8 ● F O C U S J u l y 3 0 , 2 0 0 9

C L I N I C A L N E W S

Christiana Care Formulary

Therapeutic NotesFocus on Excellence - Best Practice Medicine

■

■ Use the checklist located on theFOE website by clicking thediamond on any portal.

■ Report any issues to your organiza-tional liaison or the resource room.

■ Contact your manager or chargenurse to discuss issues in your area

■ Remind staff of the following:

(Outpatient only) All problemsummary lists are initiated by thirdvisit and updated.

■

■

■

C O N T I N U E D , N E X T P A G E

Formulary Update

Levalbuterol

T H E R A P E U T I C N O T E S , C O N T I N U E D

Thomson Micromedex Healthcare Series

When your time is your own, learn how to enjoy it

It could be as simple as reading a bookor as challenging as learning to painttranquil landscapes.

Write down your list and be as specificas possible. Instead of jotting “spendmore time in the garden,” you mightwrite “plant a rose garden by the backgate.” Instead of “exercise more,” youmight add “take a yoga class once aweek” or “walk three miles everySunday” to your list.

By making a list of leisure activitiesyou enjoy, you are far more likely tofind ways you can integrate thoseactivities into your life.

Our days are filled with so manydemands—working, walking the

dog, washing the car—that it’s oftendifficult to squeeze out an hour or twofor leisure.

But leisure time is not a luxury. It’s anecessity, an important pause thatallows us to refresh our energy level.

The rub is that many of us expectleisure to materialize spontaneously.The fact is that there are only 24 hoursin each day, and we are far more likelyto enjoy leisure if we are organizedand block out time for ourselves, justas we would for any worthwhile pur-suit.

Learn to say noA good first step is learning to say noto time vampires,those tasks that sapour hours and energy.Then decide what youwould like to say yesto and make specificplans to enjoy your-self.

It might not be easy atfirst to say no whenothers make demandson your time. Weoften feel we must sayyes and wind upresenting the peoplewho have taken upthose precious hours.

But once you haveestablished bound-aries, saying nobecomes less difficult.

By learning to say no, gently but firm-ly, we can also learn to say yes toourselves. You’ll set yourself up forsuccess by learning not to waste yourown time.

Instead of letting routine errands andhousehold chores drag out over anentire weekend, try taking care ofthem right away so you will havemore free time. (Hint: do the task youdislike most first so you don’t burnenergy avoiding it.)

Know yourselfDo you have a running list in yourbrain of things you would enjoy if youonly had the time?

1 0 ● F O C U S J u l y 3 0 , 2 0 0 9

Westside Family Healthcare, a non-profit community health center inNew Castle County, hosts the 19thannual 5K Westside Way Race/Walk,on Wednesday, Aug. 5 at theWilmington Riverfront. Registrationbegins at 5:30 p.m., the run/walkstarts at 6:30 p.m. Proceeds benefituninsured and underserved familiesby providing medical, dental andmental health care. Register online atwww.races2run.com. Contact SarahNoonan at 302-656-8292.

Christiana Care is sponsoring the18th Annual American Heart Walkon Sunday, Sept. 13 at the WilmingtonRiverfront. In addition to raisingfunds to fight heart disease andstroke, the American Heart Walk pro-motes awareness about the diseases.William S. Weintraub, M.D., FACC,chief of Cardiology and director of theChristiana Center for OutcomesResearch, is honorary chair. Join oneof several teams from Christiana Carealready listed on the Heart Walk Website. Or, call your coworkers, friendsand family and start your own team.Be sure to register your team on theWeb site. If your team raises the mostmoney or has the most walkers, youand your team will win a pizza party.

The next two presentations for theImplantable CardioverterDefibrillator (ICD) Support GroupSeries for those who have or plan toreceive an ICD, include:

■ Aug. 11, 6-7:30 p.m., VanessaDowning, Ph.D., Behavioral HealthCoordinator for the Center for Heart &Vascular Health, “Stress Managementin Action: Techniques & Practice.”■ Sept. 8, 6-7:30 p.m., Linda Lewis,RN, BSN, and Sonya Stover, RN, BSN,CCRN, Cardiovascular Nursing,“Heart Rhythms and What TheyMean.”

Call 737-8405 and request theChristiana Care blood drive now toschedule your appointment at the on-site blood drive Friday, Aug. 14 in theauditorium of the Ammon Center.Appointments begin at 8:30 a.m.

The 6th annual 21st Century Visionsof Nursing Conference, hosted byChristiana Care Sept. 16-17 at the JohnH. Ammon Medical Education Center,focuses on pacemakers, penetratingtrauma, VAP, obesity, compartmentsyndrome, renal failure and pul-monary hypertension. For more infor-mation and to register, contact CarrieBonnett at 302-428-4922 or visitwww.christianacare.org/vision-sofnursing.

The 10th Anniversary of WilmingtonWellness Days is Sept. 19 on RodneySquare, 11 a.m.-3 p.m. In the past,Christiana Cares has presented anASK the Doctor tent, cholesterol, dia-betes and cancer screenings, a Lunchand Learn, plus much more.Wilmington Wellness Day reachesmore than 3,000 individuals. If you or

your team would like to participateand reach out to the Wilmington com-munity please call Nora Katurakes at623-4628.

The 3rd Annual Renal andHypertension Symposium will beSept. 26.

The 2nd Annual Kidney Walk, spon-sored by Christiana Care, will be heldOct. 4 at 10 a.m. at Rockford Park inWilmington. Visitwww.kidneywalk.org for more infor-mation.

The Christiana Care Women’s FallHealth Lecture Series features month-ly speakers addressing a wide range ofhealth care topics. Here are the firstthree in the lineup:■ Sept. 17 – “Cosmetic Surgery:Separating Fact from Fiction,” MehdiBalakhani, M.D., Chief,Plastic/Reconstructive Surgery section■ Oct. 13 – “Legs, Veins andCirculation Health,” with ChristianaCare Vascular Specialists Inc. surgeonsMichael A. Dignazio, M.D., and SonyaN. Tuerff, M.D.■ Nov. 10 – “The Healing Power ofForgiveness,” with Margaret E.Keenan, Ph.D., clinical psychologist.All lectures above are at the John H.Ammon Medical Education Center atChristiana Hospital from 7-8:30 p.m.Lectures are free. Seating is limited.Reserve your seat today at www.chris-tianacare.org/lectures or 800-693-CARE (2273).

Upcoming events

1 2 ● F O C U S J u l y 3 0 , 2 0 0 9

C L I N I C A L N E W SC L I N I C A L N E W S

Emergency Medicine Matthew T. Judd, D.O.Christiana Hospital Department of Emergency Medicine,RM 1071 Newark, Del. 19718 Phone: (302) 733-1840

Jaime Massucci, M.D.Department of Emergency Medicine Christiana Hospital, Room 1071Phone: (302) 733-3904

Charles Schmier, M.D.Christiana Hospital Department of Emergency Medicine Newark, Del. 19718 Phone: (302) 733-1840

Family & Community Medicine Charles G. Case, M.D.601 New Castle Avenue Wilmington, Del. 19801 Phone: (302) 655-6187

Medicine/Internal Medicine Nathan G. Hamadeh, M.D.111 Continental Drive, Suite 406 Newark, Del. 19713

Phone: (302) 368-2630Yvonne M. Lyles, M.D.111 Continental Drive, Suite 406 Newark, Del. 19713 Phone: (302) 368-2630

Rekha J. Mandel, M.D.131 Continental Drive, Suite 200 Newark, Del. 19713 Phone: (302) 366-1868Charles V. Roche, III, M.D.131 Continental Drive, Suite 200 Newark, Del. 19713 Phone: (302) 366-1868

Medicine/Medical Oncology Jamal G. Misleh, M.D.Med. Onc. Hem. Consultants, PA 4701 Ogletown-Stanton RoadS-3400 Newark, Del. 19713 Phone: (302) 366-1200Medicine/Pulmonary & CriticalCare Medicine Nirav G. Shah, M.D.e-Care/Telemedicine 200 Hygeia Drive, Suite 2740 Newark, Del. 19713 Phone: (302) 623-0600

Oral & Maxillofacial Surgery &Hospital Dentistry/GeneralDentistry Amit P. Patel, D.M.D.American Dental Care, LLC 65 N. duPont Highway Dover, Del. 19901 Phone: (302) 734-7634

Pediatrics/General Pediatrics Laura F. Hall, M.D.200 Cleaver Farm Road, Suite 201 Middletown, Del. 19709 Phone: (302) 378-5104

Pediatrics/PediatricGastroenterology Katryn N. Furuya, M.D.Department ofPediatrics/Gastroenterology 1600 Rockland Road Wilmington, Del. 19803 Phone: (302) 651-5928

Surgery/Orthopedic Surgery William L. Pfaff, M.D.4745 Ogletown-Stanton RoadSuite 3302 Newark, Del. 19713 Phone: (302) 623-4144

M-D Staff Briefs

Welcome New Medical-Dental Staff

Surgery/Trauma & SurgicalCritical Care Kevin M. Bradley, M.D.MAP 2, Suite 3301 4735 Ogletown-Stanton Road, Newark, Del. 19713 Phone: (302) 623-4370

Joseph “Ted” Kestner, M.D., passestorch as Respiratory medical director

Dr. Kestner will continue to care forpatients as an attending physician butbelieves the department is in goodhands.

Vinay Maheshwari, M.D., FCCP, hasbeen named medical director ofRespiratory Therapy at ChristianaCare.

“The Department of RespiratoryTherapy is a well-organized unit,with what I believe are some of thebest health care providers in ourentire health care system,” he says. “Iam excited to help continue the highstandard of excellence that theyachieve and hope to be a positiveforce, particularly in expanding theareas of research and education.”

Dr. Maheshwari is a graduate of theMedical College of Virginia/VirginiaCommonwealth University, where hecompleted his residency in internalmedicine. He was a fellow in theDepartment of Pulmonary, CriticalCare and Sleep Medicine, NewEngland Medical Center/TuftsUniversity Hospital.

Before joining Pulmonary Associates,PA, in January 2007, he was medicaldirector of the intensive care unit atCambridge Hospital in Boston. In2006, he was Teacher of the Year atCambridge Health Alliance/HarvardMedical University.

For 25 years, Joseph “Ted” Kestner,M.D., brought skill, dedication and

compassion to his work as medicaldirector of the Department ofRespiratory Care.

Vinay Maheshwari, M.D.

M-D Staff Briefs

1 4 ● F O C U S J u l y 3 0 , 2 0 0 9

UpClose: Volunteer Earl Woodlen

Doesn’t give up

Inspired by caregivers

Always has a smile

Earl Woodlen of Wilmington has logged more than 2,800 hours as a ChristianaCare volunteer. When not at Wilmington Hospital, he is often found at theHarriet Tubman Center, a halfway house he personally runs and funds.

John Piper, M.D., honored for 16 years as Christiana Care infection control officer

John P. Piper, M.D., receives a plaque from Virginia U. Collier, M.D., honoring his service asChristiana Care’s Infection Control Officer from 1994-2009.