Volume 21, Issue 2 • may 2012

Comprehensive Gastroenterology Care at Memorial Gastroenterology Associates of York is now providing comprehensive GI care at Memorial Hospital. The practice has seven physicians who are all board certified in internal medicine and gastroenterology.

Sally Dixon

MESSAGE FROM SALLY… When the Hospital Board of Directors and Executive Leadership Group evaluated potential strategic partners, one of the items that impressed us the most about Community Health Systems (CHS) was their emphasis on physician and employee satisfaction. CHS is committed to maintaining hospital environments where physicians prefer to practice medicine. Each year, CHS-affiliated hospitals conduct physician satisfaction surveys to identify areas of distinction and opportunities for improvement. In the 2011 medical staff survey, physician respondents indicated: (continued on page 2)

Additional Practices Offering Gastroenterology Care at memorial

These practices are located near Memorial Hospital and offer convenient gastroenterology care to area patients: • Internal Medicine Consultants 1777 Fifth Avenue • 843-8051 www.imcyork.com • Elmwood Medical Center Associates 1600 Sixth Ave, Suite 114 • 755-1244 www.elmwoodmedical.com

Dr. Jim Srour, senior partner at Gastroenterology Associates of York said, “The physicians of Gastroenterology Associates represent a broad cross section of training in medicine and particularly in the digestive sciences. Our experience and training is augmented by our alliances with several academic centers including John’s Hopkins, University of Maryland and Hershey Medical Center, as well as Albert Einstein Hospital, Temple and Jefferson in Philadelphia, University of Virginia and SUNY in New York. Using our collective resources as well as the easy access to academic specialists at these centers, we are able to help with the diagnosis and treatment of virtually all known GI disorders. This allows opportunities to offer comprehensive, innovative and compassionate care.” Jim Gill, chief operating officer at Gastroenterology Associates of York added, “We decided to join the staff at Memorial because it is good for the community. We always want to provide what our growing community needs. There was a growing need for pediatric GI services in our community. Through an arrangement with Dr. M. Azim Qureshi, a board certified pediatric gastroenterologist from Carlisle, we have been able to meet this need. Dr. Qureshi is able to see patients in our York office so children and their families do not have to travel out of town for this care.” Dr. Srour further explained, “Our goal is to be able to make these specialty services accessible to more people in York County. Being members of the Memorial staff will give us an opportunity to reach a larger segment of the population. Our services will include consultative care, endoscopic procedures including ERCP, and other specialized testing including motility studies, pH testing, wireless capsule endoscopy and ‘Smart Pill’ technology.” Physicians from Gastroenterology Associates are available for advanced diagnosis and treatment including colonoscopy, upper endoscopy, colon cancer and polyp screening, irritable bowel syndrome, Crohn’s disease, ulcerative colitis, abdominal/stomach pain, heartburn and acid reflux, Barrett’s esophagus, swallowing problems, gallbladder disease, liver and pancreatic disease, cancer detection, hepatitis and changes in bowel habits. “Memorial’s Outpatient Endoscopy Center is a beautiful facility, offering a comfortable and private setting for those needing outpatient colonoscopies and upper endoscopies. It will be a privilege to offer services at Memorial,” added Dr. Srour. For more information, visit www.gastroyork.com or call 741-1414. The practice has dedicated phone lines for referring physicians.

325 South Belmont Street • P.O. Box 15118 • York, PA 17405 • 1-800-436-4326 or 717-843-8623 • www.mhyork.org

Welcome Dr. Srour! Dr. Zaher Srour recently joined Memorial Health Systems. As an otolaryngologist, Dr. Srour treats ear, nose, and throat (ENT) disorders including allergy testing and treatment; hearing and balance disorders; sinusitis and chronic sinus headache; nasal obstruction; snoring and sleep apnea; voice and swallowing disorders; head and neck tumors; and facial plastic surgery. He also specializes in facial cosmetic and reconstructive surgery and is a member of the American Academy of Otolaryngology– Head and Neck Surgery. Dr. Srour completed a fellowship at Columbia University in skull base surgery as well as facial plastic and reconstructive surgery. He is a member of the North American Skull Base Society. In 2007, Dr. Srour moved from Manhattan, NY, to Hanover, PA. “I was looking for a more family-oriented area and decided this was a great place to move my practice,” he said. Dr. Srour lives in the York area with his wife, Maria, and three children. Outside the office, Dr. Srour enjoys spending time with his family and has a “green thumb” for gardening. He plants both flowers and vegetables and is dedicated to natural, organic gardening.

Sally’s Article continued…

• 91 percent would recommend the CHSaffiliated hospital where they practice to family or friends; • 92 percent were satisfied with the competency of nursing staff; and • 96 percent were satisfied with how effectively and sensitively families of patients are handled throughout their interaction with the hospital. Nearly 6,500 physicians responded to the 2011 survey, which is a very strong response rate of 59 percent. I look forward to working with you as we enter the next phase of Memorial’s future. If you have any questions about our transition to CHS, please contact me at 849-5340.

Dr. Srour’s office is in Suite 103 at Hillside Medical Center, 250 Fame Avenue in Hanover. For more information or to contact Dr. Srour, call 632-2221 or visit www.HanoverENT.com.

Sincerely,

Physician Reminders

President and CEO

• Faith Zeigler, director of Health Information Services, asks physicians to please be sure their patient records are up to date for the transition to Community Health Systems on June 1. If you have any questions, please call Faith at 849-5306. • Rose Rupert, Memorial’s Vascular Management coordinator, reminds physicians to please use the new Central Venous Catheter (CVC) order sets implemented February 1. Also, physicians now need to use the continuation order sheet daily for the necessity of the line. Please call Rose at 843-3580 if you have questions. • Julie Williams, Memorial’s team leader in the Sleep Lab, is reminding physicians that the insurance companies are requiring an office visit between 30 and 90 days during the therapy when patients are set up with CPAP or BIPAP. Physicians also need to document that the patient is using the equipment at least four hours each night for 21 nights (70 percent) during any consecutive 30-day period in the first three months. Documentation of the OSA symptoms improving and adherence to therapy should be noted in the medical record.

Each Time, Every Time: Accurate Patient Identification

Cutting it Close. FastER. Come to us for your emergency care. Great physicians. Great nurses. And emergency care.

The intent of patient identification is to match the correct service to the correct patient and to properly identify the patient in need of health care services. Each time, every time you interact with a patient, please: • Validate you have the correct patient by asking the name and date of birth. • Ask for a time out before a special procedure to confirm the right patient, the right test and the right process. Memorial Hospital • Breast Center • Endoscopy Center • Greenbriar Medical Center Heart and Vascular Center • HomeCare of York • Industrial Resource Center Memorial Primary Care • Surgical Center of York • White Rose Hospice

Dr. Piccolo Receives Honor

medical staff information changes Dr. Anthony Piccolo was named Memorial Hospital’s first distinguished fellow of the American College of Osteopathic Obstetricians and Gynecologists (ACOOG) at the 79th annual conference. He was also named the 2012 ACOOG Mentor of the Year. Pictured at the conference with Dr. Piccolo are Dr. Lisa Fritz, far right, and Memorial Hospital past residents, from left, Drs. Marydonna Ravasio, Laurie Allen, Kristi Herbst and Deborah Milstein-Herchelroath.

Welcome Dr. Treat! “Working in emergency medicine is where I’m most comfortable,” says Dr. Treat. “I love talking with patients and giving a hand to help when they are in need.” Working with residents to help them learn the art of being an emergency physician is also something she enjoys. In addition to practicing Emergency Medicine, Dr. Treat has served as medical director for Maryland’s Carroll County EMS and the Westminster SWAT team. She was the lead author of a 2001 article published in Annals of Emergency Medicine entitled “Hospital Preparedness for Weapons of Mass Destruction,” the first article of its kind to be published after 9/11. When she is not caring for patients, she is busy with her two sons: Thomas, 6, and Justin, 5.

Application for Appointment The physicians listed below have recently applied for medical staff appointment and/or privileges at Memorial Hospital. If you have any information concerning these applicants that may assist the Credentials Committee, please provide that information to Bernadette Emig, Medical Affairs manager, or Carl Colombo, D.O., chairperson of the Credentials Committee. Daniel J. Johnson, M.D. Emergency Medicine

Chad A. Griffith, D.O. Emergency Medicine

Stewart O. Sanford, M.D. Emergency Medicine

Rebecca Chamberlain, D.O. Voluntary Resignation Brett Himmelwright, D.O. Voluntary Resignation John Jensen, D.O. From Active to Courtesy

Dr. Kimberly Treat is Memorial’s new physician in Emergency Medicine. Dr. Treat attended The Bowman Gray School of Medicine and completed her residency at West Virginia University Hospitals.

Nikhilesh N. Agarwal, M.D. General Surgery

Meagan Bilbrough, D.O. Voluntary Resignation

Michael T. Williams, D.O. Emergency Medicine

Ronald Malcom, M.D. Voluntary Resignation James Sullivan, D.O. Voluntary Resignation

Dr. Hugh Palmer Named Physician of the Year

Dr. Hugh Palmer and his wife, Linda

Memorial Hospital’s Dr. Hugh Palmer was named Physician of the Year during Central Penn Parent’s Healthcare Heroes event held in Harrisburg. Additional Memorial winners include: Robert Elicker, Volunteer of the Year; Joyce Page, Nurse of the Year; and Diane Deitz and Kendra Greene, Hospital Heroes. The Healthcare Heroes competition is held annually to recognize outstanding physicians, nurses, volunteers, health educators, employees and organizations making a difference in the central PA region.

Congratulations, Dr. Sharma! Dr. Garima Sharma with York Heart and Vascular Specialists represented Memorial Hospital at the recent American College of Cardiology (ACC) convention of 20,000 national and international cardiologists. Dr. Sharma was co-chair and a speaker for the ACC’s “Heart Songs” CME course attended by a record-breaking 853 attendees. Additionally, Dr. Sharma has been selected to help plan the ACC’s November 2012 Mid-Atlantic Chapter convention to be held in Washington, D.C.

325 South Belmont Street P.O Box 15118 York, Pennsylvania 17405

HomeCare of York Offers Lymphedema Therapy Memorial HomeHealth Services is pleased to announce Christy Commins, a lymphedema therapist, has joined the HomeCare of York team. Christy holds a bachelor’s degree in physical therapy, a master’s in health sciences from the Medical University of South Carolina and is certified by the Chikly Institute in lymphedema management. “Lymphedema is a condition similar to a beaver building a dam,” Christy said. “The stream can no longer run smoothly and there is a back up of water. The dam must be redirected in order for the water to run effortlessly again.” Primary lymphedema is usually a birth or congenital defect. Secondary lymphedema is the most common, and it can be caused by damage to the area of an intact lymphatic system. Early detection of a damaged lymphatic system is important for optimal treatment. In all cases, if not treated, the involved area will continue to swell and wounds often evolve. When this occurs, patients live with chronic pain, risks of infection, immobility, isolation and frequent hospitalizations. Lymphedema is treated by compression therapy, which consists of using compression wraps, garments or stockings. The compression wraps allow fluid to be slowly and effectively redirected to a healthy area. With compression therapy, patients see results in a short treatment time. Contraindications for compression therapy are ischemia, uncontrolled congestive heart failure and untreated septic phlebitis. Active cancer, or the treatment of it, is not a contraindication. If a patient is undergoing chemotherapy, lymphedema therapy must be placed on hold until 48 hours after the chemotherapy. For more information about lymphedema therapy, please call Christy at 887-9369.

New Behavioral Response Team “Code Orange” refers to Memorial’s new behavioral response team (BRT) that responds to a threat or potential threat to the safety of hospital associates, patients and visitors. According to Joe Barron, Memorial’s director of Safety and Security, the purpose of Code Orange is to de-escalate potential violent situations and bring them to a successful closure. All members of the behavioral response team have received training in crisis intervention tactics and in the proper use of restraint. Training is ongoing and includes physical and verbal skills that help in de-escalating a situation. BRT members can be identified by orange stripes on their identification badges. A Code Orange may be activated by a supervisor, manager or team leader in the affected area by contacting the administrator on duty, vice president of Patient Services, clinical supervisor or the Safety and Security department. In an emergency, or when time does not permit following the protocol, an associate may activate Code Orange by calling the emergency number “777” and informing the Switchboard. For more information, please call Joe at 849-5337.

Please Remind Your Patients to Pre-Register!

717-815-2351 Pre-registration appointment cards are available for your office by calling Jeri Lowery at 815-2797.

MEDICAL STAFF Additions Duane E. Ahlbrandt, M.D. Roland Friedrich, M.D. Rohit Jindal, M.D. Sumita R. Mehta, M.D. Guoxiang Shi, M.D. James W. Srour, M.D. Pin Wang, M.D. Gastroenterology Associates of York 2690 Southfield Drive York, PA 17403 741-1414 • Fax 815-4314 Specialty: Gastroenterology Ammar Al-Laham, M.D. WellSpan Nephrology 380 St. Charles Way York, PA 17402 851-6040 • Fax 812-3190 Specialty: Nephrology Elizabeth Azubike, M.D. WellSpan Lung, Sleep and Critical Care 2350 Freedom Way, Suite 200 York, PA 17402 851-2465 • Fax 741-3043 Specialty: Pulmonary Medicine Craig Bryant, M.D. EMP of York 325 S. Belmont Street York, PA 17403 849-5730 • Fax 849-5731 Specialty: Emergency Medicine

The Treatment of Sudden Cardiac Arrest by Ronald J. Savarese, D.O.

Sudden cardiac arrest (SCA) results in 350,000 deaths per year in the United States, more deaths than from lung cancer or breast cancer. SCA is responsible for 50 percent of all cardiac deaths. Forty percent of SCA episodes are not witnessed and only 20 to 30 percent of out of hospital SCA victims survive to hospital discharge.

MEDICAL STAFF Additions (continued) David Coutin, M.D. Allergy and Asthma Consultants, Inc. 1620 S. Queen Street York, PA 17403 843-6663 • Fax 852-0670 Specialty: Allergy, Asthma and Immunology John J. Lawrence, M.D. The Women’s Healthcare Group 1693 S. Queen Street York, PA 17403 845-1621 • Fax 854-6939 Specialty: Obstetrics and Gynecology Kimberly Treat, M.D. EMP of York 325 S. Belmont Street York, PA 17403 849-5730 • Fax 849-5731 Specialty: Emergency Medicine Ronald Vandegriff, D.O. Family Health Associates 2190 N. Susquehanna Trail York, PA 17404 852-7766 • Fax 852-7862 Specialty: Family Practice

Data collected from the 2008 U.S. Census with unofficial, nonscientific projections for 2010 estimated that of the York County population over the age of 45: 7,900 will have the diagnosis of heart failure; 12,096 will suffer an acute myocardial infarction (MI); 35,069 will have the diagnosis of coronary artery disease (CAD) and 654 people over the age of 65 will die from SCA. One hundred people between the ages of 35 to 64 will also suffer SCA. These estimates are projected to steadily increase over the next decade. The best treatment for SCA is prevention; the best prevention is an implantable cardiac defibrillator (ICD). The challenge physicians face daily is identifying the patients at risk and referring them for treatment. It is estimated that 10 to 13 percent of patients qualify for, but do not receive, an ICD because it is not recommended to them by their physician. Forty-five percent of people who suffer SCA were seen by a physician within four weeks prior to their event. Multiple risk factors for SCA have been identified including: family history of CAD or SCA; unexplained syncope or near syncope; palpitations, angina or dyspnea with exertion; risk factors for CAD; personal history of a MI or CHF; and reduced left ventricular systolic function. The strongest predictor of SCA is left ventricular systolic dysfunction of any cause. Many trials have focused on the use of ICDs. One of the first was Multicenter Automatic Defibrillator Implantation Trial II (MADIT II). MADIT II explored conventional therapy versus ICD therapy in patients who suffered a MI and had a left ventricular ejection fraction (LVEF) ≤ 30 percent. The results showed a 31 percent reduction in all cause mortality in the ICD arm. Another landmark trial, “The Sudden Cardiac Death in Heart Failure Trial” (SCD-Heft) compared conventional therapy versus ICD therapy versus amiodarone therapy in ischemic and non-ischemic patients with a LVEF < 35 percent and Class II-III heart failure. ICD therapy resulted in a 23 percent reduction in all cause mortality compared to other therapy. These and other trials have identified a LVEF ≤ 40 versus as a level of concern. Any patient with an ejection fraction within that range should be evaluated to determine if they meet criteria for primary prevention against SCA by ICD placement. To assist you on the front lines of preventive care, the list below will allow you to quickly identify the majority of your patients at risk for SCA: • LVEF < 40% • Heart failure, New York Heart Association Class II-III • Syncope or near syncope • History of CAD and palpitations An evaluation by an electrophysiologist would be reasonable if you answer “yes” to any of these findings. Further information concerning SCA can be found on the websites of the Heart Rhythm Society (www.hrsonline.org) or the American College of Cardiology (www.cardiosource.org/acc). Please contact us at York Heart and Vascular Specialists to discuss any patient you consider at elevated risk for SCA. 1600 Sixth Avenue, Suite 105 • York, PA 17403 Tel: 717-849-5576 • Fax: 717-718-9972 www.yorkheart.com