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In This Issue
Remembering Alan Gilstein
by Kathleen C. Hittner, MD
The Miriam Hospital has recently suffered the loss of a good friend, Alan Gilstein, who fought a courageous battle against cancer.
Alan had been part of The Miriam since 1976, when he began serving on the hospital’s finance committee. Thus began a long relationship with the hospital, one that would span decades and see The Miriam flourish.
In 1978, Alan became a member of the board. He served faithfully for 22 years, dedicating himself to the hospital and becoming chairman of the board of trustees in 2000.
I knew Alan Gilstein from the day I came to town in 1979. He was the accountant for the anesthesia group that I joined here at The Miriam Hospital. He served as an accountant to many physician groups. He understood our issues and helped us to understand the tax code. I am proud to say that when I was leading the anesthesia group many years later, the IRS audited our accounts for three years. I was really nervous, but thanks to Alan’s good work on our accounts everything was perfect! I simply could not believe what a good job he had done.
More recently, Alan stood by my side at very difficult hearings at the Health Department and City Planning Commission as we sought permission to build the Baxt Building. His calm demeanor and keen negotiating skills taught me a great deal and helped me to be able to handle such meetings in the future. He made me realize that no one was attacking us personally; they were looking out for what they thought were in the best interests of the community, the patients and the neighbors.
Besides helping me with the political side of building the Baxt Building, he helped me raise money to help build the building. He was the one to convince me to ask Victor and Gussie Baxt for a $5 million total pledge to name the building. This wonderful couple had already given us $2 million and I thought asking for more was just too much and that they might think I didn’t appreciate what they had already done. He convinced me they would be honored to be asked and he was right. He taught me to reach for the sky in fundraising as our hospital needs that money to accomplish all our goals.
Alan’s dedication to the hospital was visible through his family’s actions. His wife, Suzanne, a nurse has worked here for years. Their daughter, Debbi, started her career in the marketing department and now oversees fundraising at The Miriam Hospital. Their son, Adam, also works at The Miriam Hospital in the transport department. Clearly, Alan’s work to make this hospital the best that it can be was reflected in his family’s decision to work here.
He was always proud that his wife was a nurse and proud that we had such a great nursing department here. In fact he and his wife set up the Alan and Suzanne Gilstein Nursing Symposium Endowed Fund for nursing education. The proceeds from this fund will enable the nursing department to bring in outside professional speakers for formal lectureships.
I am grateful for all he has done for The Miriam Hospital. We are a better facility and a better hospital because he was here to help us. He helped us to build not just facilities but a balance sheet. He always told me, “cash is king.” Make sure you have balanced spending and savings. He was a very practical man.
I will miss him as will many around us. We plan to plant a tree in his honor so that we will think of him as we watch the tree bloom and grow.
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Awards
Nestor Named 2008 Woman Physician of the Year
Elizabeth Nestor, MD, MDiv, FACEP, of The Miriam Hospital’s department of emergency medicine, was named the 2008 Woman Physician of the Year. This honor, granted by the Rhode Island Women’s Medical Association, was awarded to Nestor at a reception held in May at the Providence Marriott Hotel. Nestor delivered a lecture titled The Intimate Science: 100 Years of Medical History in Rhode Island.
Nestor’s education took her from the University of Rhode Island, where she received her bachelor’s degree in 1973, to Yale Divinity School, to Northwestern University Medical School. She received her medical degree in 1991, after which she completed her residency in emergency medicine at the Medical Center of Delaware.
Nestor is currently a clinical associate professor of emergency medicine at the Warren Alpert Medical School at Brown University, as well as an attending physician at both Rhode Island and The Miriam hospitals. Since 1996, Nestor has been The Miriam’s emergency department risk management coordinator. During her tenure as coordinator, there has been 100 percent compliance with the goals of risk management.
(table of contents) Mayer Receives Lifetime Achievement Award
Kenneth Mayer, MD, FACP, was chosen to receive the American College of Physicians, Rhode Island Chapter, Milton Hamolsky Lifetime Achievement Award.
Mayer, the editor of the Journal of Clinical Infectious Diseases, has a history of dedication to the study of HIV/AIDS. In 1982, he was a member of the mayor’s ad hoc committee on AIDS in Boston and was involved in study groups and committees studying the virus over the next two decades. Mayer teaches classes on HIV/AIDS at the Warren Alpert School of Medicine at Brown University, where he has taught for over twenty years, as well as at the University of Rhode Island.
For nearly ten years, Mayer has been on the executive committee of the Lifespan-Brown-Tufts Center for AIDS Research. In 2006, Mayer worked with Family Health International, a nonprofit organization active in international public health, on a study researching the prevention of HIV among South African women. In 2007 alone, he received a grant from the NIH to study HIV infection and prevention in South Indian truck drivers, and authored articles with subjects ranging from the willingness of incarcerated persons to receive HIV vaccines to peer-based intervention as a method of HIV prevention.
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Other News
Patient Safety Notes and Campus Updates
 by R. William Corwin, MD
The Miriam Hospital Medical Executive Committee and staff are committed to all aspects of patient safety and the national patient safety goals. One of the key elements is the universal policy on site and side, and operating room and bedside procedure time outs.
Bedside Procedures
A notice to all The Miriam physicians was sent in early April regarding the expectations and compliance with the universal policy for site and side for all procedures not done in the operating room. Attached to the fax was an attestation for every physician to sign and return to the medical staff office. It is the expectation of The Miriam Hospital Medical Executive Committee and the hospital’s board that there will be 100% compliance with the use of this form and the process of having a nurse present at the time of the procedure, a time-out, patient identification, site and side identification, and agreement before beginning the procedure.
Steps we need to take before every invasive procedure:
- Inform the patient’s nurse that the procedure is about to happen. Include the nurse in the patient identification and time out.
- If the nurse is not available, ask the unit secretary to notify the covering or charge nurse. Include the nurse in the patient identification and time out.
- Fill out a bedside procedure form.
- The form is used to document consent, time-out and the procedure note.
- This counts as the procedure form, but write an additional note in the progress notes if more description is needed.
- The "time-out" section must be completed.
- Two signatures are needed to indicate that the patient identification and time-out were completed according to hospital policy.
Frequently Asked Questions
- What is an invasive procedure?
Almost all procedures we do, with the exception of blood draws (fem stick, abg) are invasive procedures. These include, but are not limited to:
- Central/arterial lines
- Paracentesis
- Thoracentesis
- Intubation
- Incision and drainage
- Lumbar puncture
- Joint aspiration
- Bone marrow biopsy
- Chest tube insertion
- Bronchoscopy
- Where do we find the bedside procedure forms?
The forms are attached to all kits that we use. If you are doing a procedure that does not have a kit or if the kit does not have a form attached, then pick up a form from the nurses' stations. The stations have the forms in the rack of physician forms; otherwise ask the unit secretary.
- Do I use the form in emergency situations (e.g., emergent intubations)?
Obviously, do not delay care to fill out the form, but make sure to fill out the form as soon as possible. In these cases, consent may be “N/A.”
- If I wrote a procedure note, do I still need to fill out the bedside procedure form?
Yes, the form needs to be filled out because our procedure notes do not document the time-out process. (The universal protocol is an important patient safety and Joint Commission requirement).
The Department of Health (DOH), with the help of the Hospital Association of RI, is developing a uniform universal policy form to be used at all hospitals. There will be more to come on this endeavor as it develops.
Reportable Events to the RI DOH
Did you know that there are specific medical and institutional events and incidents that must be reported to the RI DOH? This is accomplished through our risk management department. When these occur, you should call the Lifespan risk management department at 793-2017 to notify them. They will determine whether any of the following event(s) must be reported. The list identifies any medical or surgical events and/or injury to a patient, sustained while in our care, as follows:
- Brain injury
- Mental injury
- Paraplegia
- Quadriplegia
- Any paralysis
- Loss of use of limb or organ
- Any serious or unforeseen complication, that is not expected or probable, resulting in an extended hospital stay or death of any patient. (While this is a broad category and to many seems vague, reporting of this category is critical.)
- Birth injury
- Impairment of sight or hearing
- Surgery on the wrong patient
- Subjecting the patient to a treatment or procedure not ordered by the attending
- Suicide during treatment or within 5 days of discharge
- Blood transfusion error
- Medication error
- Any other incident reported to the malpractice self-insurance program
These events must be reported to the Lifespan risk management team within 24 hours and to the RI DOH within 72 hours!
Over-report to the Lifespan risk management department if you have any concerns and allow the risk management experts to determine if the incident needs reporting to the DOH. If you have any questions about the reportability of an event, please contact our risk management department for consultation. It can be reached at 793-2017.
Upcoming Joint Commission Visits
The Joint Commission (TJC) will arrive sometime in the very near future for an unannounced review. There will be two surveys this year. One will be a site survey for the Stroke Center; the second is our triennial hospital review. Both surveys will be unannounced. TJC surveyors will be visiting all our patient care units while they are on campus. They will be tracing patients through their hospital stay. They will review both closed records and active records of patients on our units. The surveyors will be approaching our staff and physicians to ask questions about our processes and system. It is important that you be prepared when a surveyor approaches you. Here are some helpful suggestions:
- The quality department sent all physicians the TMH Patient Care and Safety Guide. This little blue guide will provide you a summary of the national patient safety goals (NPSG). TJC will focus on these goals.
- Be prepared to talk about your departmental quality improvement goals. If you are not familiar with them, please contact your department's quality representative to obtain this information.
- Know what the hospital’s PDCA process for quality improvement is and what the abbreviation stands for: Plan, Do, Check, Act (act to expand or redesign the quality improvement plan).
- The five Miriam (and Lifespan) quality indicators are:
- PCI within 90 Minutes
- Hospital acquired pressure ulcers
- ACE or ARB at D/C for CHF patients
- In-hospital MRSA transmission rates
- Antibiotics within one hour of incision at surgery
- The five Miriam safety indicators are:
- Hand hygiene compliance (This is a new Lifespan-wide measure looking at hand washing when people are going into and coming out of the room.)
- Critical care blood stream infection rates
- Critical care urinary tract infection rates
- Critical care ventilator-associated pneumonias
- Hospital-acquired MRSA infection rates
Smoke-Free Campus:
The Miriam will be moving to a campus-wide no smoking policy on November 20, 2008. At that time, there will be no smoking area on The Miriam campus for patients to use while hospitalized.
There will be no mechanism for the patients to leave (for that cigarette they feel they desperately need). Therefore, consider ordering nicotine patches as needed for your patients and DO NOT write orders to allow the patients to leave the building for a smoke.
Thanks and enjoy the spring. (table of contents)
Milestones
Congratulations to the following Miriam Hospital physicians, who have reached milestones in their careers at the Warren Alpert Medical School of Brown University:
- Edward Feller, MD, clinical professor, 30 years
- Ronald Gilman, MD, clinical assistant professor, 30 years
- Rex Appenfeller, MD, clinical assistant professor, 25 years
- David Fortunato, MD, clinical associate professor, 25 years
- Michael Scilari, MD, clinical assistant professor, 20 years
- Richard Morgera, MD, clinical assistant professor, 15 years
- Christine Herbert, MD, clinical assistant professor, 15 years
- Douglas DeOrchis, MD, associate professor, 15 years
- Robert Shalvoy, MD, clinical assistant professor, 15 years
- Paul Gordon, MD, assistant professor, 15 years
- Warren Licht, MD, clinical assistant professor, 15 years
- Anne Cusing-Brescia, MD, clinical assistant professor, 15 years
- Beverly Walters, MD, clinical assistant professor, 15 years
- Jon Lambrecht, MD, clinical assistant professor, 15 years
- Robert Schwengal, MD, clinical assistant professor, 15 years
- Papa Kaku Badoe, MD, clinical assistant professor, 10 years
- James Bass III, MD, assistant professor, 10 years
- Jonathan Movson, MD, assistant professor, 10 years
- Syed Hussain, MD, clinical instructor, 10 years
- Martin Elson, DDS, clinical instructor, 10 years
- William Binder, MD, clinical instructor, 10 years
- Mary Palmer, MD, clinical instructor, 10 years
- Russell White, MD, clinical associate professors, 10 years
- David Neumann, MD, assistant professor, 10 years
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Video Feature: Center for Cardiac Fitness
More than 2 million Americans become eligible for cardiac rehabilitation each year after an MI or coronary revascularization. However, an average of only 15 percent of eligible candidates are referred to a cardiac rehabilitation program. Research from the American College of Radiology and the American Heart Association suggests that all cardiac patients should participate in cardiac rehab in order to ensure the highest possible quality of life and reduce the likelihood of future cardiac events.
 
See The Miriam's Center for Cardiac Fitness in action.
(Windows Media Video)
At the Center for Cardiac Fitness at The Miriam Hospital, those who enter our cardiac rehabilitation program have a common purpose. Throughout the center, there is a desire to better understand, and learn how to live with, heart disease. The center is one of only a few in the state to be accredited by the American Association of Cardiovascular and Pulmonary Rehabilitation. Its goal is to provide the correct balance of exercise, nutrition, stress management, education, and individual support services that will help your patients incorporate heart healthy habits into their everyday lives.
Visit the Center for Cardiac Fitness online.
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The Center for Prisoner Health and Human Rights:
An Interview with Charles Carpenter, MD
by David Cohen, research assistant to Josiah (Jody) Rich, MD, MPH and Curt Beckwith, MD in the department of medicine, division of infectious diseases.
 Over the past two decades, doctors affiliated with The Miriam Hospital and the Brown community have received numerous grants and published extensively in the field of correctional health care, particularly in the area of treating HIV/AIDS in incarcerated populations. As a result, Rhode Island currently has one of the best state correctional health systems in the country for treating HIV/AIDS. In 2005, Jody Rich MD, MPH and Scott Allen MD, created the Center for Prisoner Health and Human Rights. Rich, of the division of infectious diseases, and Allen, attending physician at the Eleanor Slater Hospital and former medical director for the Rhode Island Department of Corrections, recognized that the Brown community has achieved a critical mass of faculty involved in the care, education and research on incarcerated populations, and they conceived of the center as a means of fostering more effective, cohesive and competitive functioning as a group. According to Rich, “the growth of the center will allow us to be more competitive at bringing in funding for our three-fold mission of teaching, care and research.”
The growth of the community of doctors committed to correctional health care in Rhode Island is due in large part to the strong relationship that has been built between the Brown community and the Rhode Island Department of Corrections (RIDOC). This relationship traces back to 1986, when Dr. Charles Carpenter, MD then physician-in-chief at The Miriam Hospital, first set foot in a Rhode Island prison. I interviewed Carpenter about this event, the history of the relationship between Brown and RIDOC, and also asked for his insight into the future of the Center for Prisoner Health and Human Rights.
“In 1987, one of my patients was incarcerated. She called from the prison because she was having some health problems. By the time I got down there, they had arranged for me to see another woman with HIV as well. Nobody in the prison knew quite what to do with this patient. I was there with Stephanie Chafee, RN who was the nurse working with me. They didn’t want us to go in the prison at that time so they had the patients go to another building, where we saw them. They were so concerned about HIV/AIDS at the time that both patients were dressed in bright orange jumpsuits with biological hazard signs on them. We examined them, despite the fact that the conditions were less than ideal, with no real privacy. Both had minor problems that did not require a lot of effort to deal with, and they were both appropriately treated. Following that, I received three more phone calls over the next couple of months about incarcerated patients. I started seeing patients at the prison periodically over the next couple of years, and it was pretty clear that the prevalence was higher in the prisons than in the general population by that time.
“So it was in probably 1988 that the prison wanted to start offering testing to all of the patients, which is interesting. I told them that a lot of people in the state felt that this would be a huge imposition. There was a lot of opposition by a number of rights groups because up to that point the people who had HIV were a pretty discriminated against group in the state. The state director of health was concerned that if the opposition from Brown was strong, they would not be able to offer optional testing there. I made an agreement with Dave Greer, who was the dean of Brown Medical School at the time, that we as a group would not oppose testing if we could care for the HIV infected persons. And that was kind of a Faustian agreement, but it did allow us to start seeing patients regularly there, and it did allow the state to start offering testing in the prison.
“They had on-site nursing there, and there was a physician on call; the nurses provided all of the care. The two nurses there were good people, but they had no knowledge of HIV infections (in fact none of us had much knowledge at that time). As the time went on there were more and more serious infections in the prison population related to HIV. So we had an agreement that from that time on they would let us see patients there at regular intervals. And it became clear that we would need a much larger program.
“I think that when Tim Flanigan came in 1991, he came with the idea that he would spend a day at the prison each week. He did such a wonderful job getting students involved that the scope of the program gradually enlarged. Scott Allen went down there as one of the physicians and eventually Brown essentially took responsibility for getting people appointed to take care of all prison health care. It has made a huge impact on the prisons, because nobody going down there--the students, or even the senior physician--would tolerate patients being put in bright orange jumpsuits with biological hazard signs pasted on them, and it has become very much more humane.
“If you look at what has happened in other states--with Tim and Jody’s leadership, our system has really become a beacon--it has become probably the best state penal institution in the country regarding HIV care because you don’t have people going in and dying of undetected illness. What they’ve done in terms of providing follow-up care is fantastic. Jody, through the Ryan White programs, has everybody lined up for care following incarceration if they have HIV infection, which has been a remarkably effective program. But it started with the two people in bright orange jumpsuits.”
What do you see as the goal, and the future direction of the Center for Prisoner Health and Human Rights?
“One of the things that would be helpful would be to get other universities involved in this sort of thing. At one time, one of the early residents with Tim and I wrote an article suggesting that one of the best ways to improve health in the prisons is to have every prison twin with a medical school. Of course, that was a very, very idealistic approach; it’s never going to happen. That sort of thing has not happened to the extent that it should in New York City, for instance. University of Alabama has a great AIDS program, but Alabama, a very poor prison health system. I just think it’s a very viable concept. It’s not going to be possible for every prison to be linked up with a university. But I’d like to see it accepted and publicized and realized in other places. They haven’t done this in Pennsylvania I don’t think – although one of our former residents from Miriam is down there doing work in the prisons. Hopkins is doing it. John Bartlet, a close friend who was head of infectious diseases there for a long time, is running the program.”
So one of the best things we can do is set a great example, and I think we already do, thanks in large part to you!
“No, no! Thanks in large part to the patients in orange jumpsuits. It was terrible to see that: these first two patients who had that, on top of their drug problems, their incarceration and everything else, to have stigma attached to it as well at that time.”
Drs. Carpenter, Flanigan, Rich, Allen and the many other members of the Brown medical community have worked with Rhode Island’s incarcerated population over the past two decades. Thanks to them, Rhode Island is a leader in setting national standards for the diagnosis, treatment and linkage to medical care for prisoners with HIV/AIDS upon release from imprisonment. With the growth of the Center for Prisoner Health and Human Rights, the Brown medical community will continue to broaden its relationship with the RI Department of Corrections and integrate an increasingly interdisciplinary team of health care professionals into the field of correctional health care.
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Miriam Researchers Present at Moses Brown
The eighth graders at Moses Brown School recently received help from the experts for their semester long science project. Who better to answer questions about the scientific method than researchers who work with the method every day?
Maria Mileno, MD head of The Miriam Hospital’s institutional review board, is the mother of one of the eighth grade’s budding scientists. She knew that the Centers for Behavioral and Preventive Medicine have a wealth of talented researchers and she wondered if one of them might be willing to share his or her knowledge.
Laura Stroud, PhD volunteered her services. Stroud and her research assistant, Jennifer Costa, are currently working on a National Science Foundation-funded study of stress and depression in adolescents. Stroud and Costa discussed the scientific method in both general and specific terms, reviewing the steps and sharing their own processes and how each step enhanced and refined their research.
Costa explains that the students “are now in the stage of coming up with a question that is good enough to study, that is, testing something that can actually be measured, asking a question that can reasonably be answered by performing an experiment.”
Stroud and Costa demonstrated the process by which they came to their own question; first, they wondered, “Why are adolescents more likely to be depressed than children?” That question led them to others, such as inquiries about the higher depression rates in adolescent girls when compared to boys of the same age. Finally, they hypothesized about stress responses and how they relate to depression.
After sharing with the students the progression of their research, Stroud and Costa ended by reminding the students, “ As scientists, we should always be asking questions. There’s always more to learn.”
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An Evening for Men and Those Who Love Them
The Miriam Hospital will present a men’s health community event on Tuesday, June 24, from 6 to 8:30 p.m. at the Ramada Inn in Seekonk, Mass. The event will offer participants a chance to learn about men’s health at midlife and explore treatment options for common men’s health issues.
To register yourself and your spouse, your partner or your friends for this free event, call the Lifespan Health Connection at 401-444-4800 or 1-800-927-1230 or register online.
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Officers & Staff |
Medical Staff Association
Christine Herbert, MD, President
Richard Gold, MD, Vice President
Peter Karczmar, MD, Secretary
Steven Graff, MD, Treasurer |
The Miriam Hospital
Jeffrey Brier, Chairman, Board of Trustrees
Kathleen C. Hittner, MD, TMH President and CEO
Sandra Coletta, Senior Vice President and Chief Operating Officer
Susan Ryan, Editor
Lauren Thacker, Writer |
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