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March 15, 2016
“If you don’t know where you are going, well
any road can take you there.”
–George Harrison
The Scope appreciates the enthusiastic response of readers contributing quotes. This quote was
submitted by Cindy Boyack, M.D. Please submit a favorite you’d like to share with others by emailing
to: [email protected]
Dear Members of the Maine Medical Center Medical Staff,
Thanks to those of you who took us up on the invitation to attend a special town meeting to
participate in a strategic planning session for Maine Medical Center. We had a great turnout, and
will keep you posted on anything new in the development of a three-year plan.
In this issue, Dr. Josh Cutler has an update on the current state of MMC’s infection prevention
efforts and clarifies recent reports on Medicare’s Hospital Acquired Conditions (HAC) program,
which has been reported in the news media.
Also, we have outlined a few opportunities for CME credit. On April 6th, MaineHealth Information
Services and Clinical Documentation Improvement departments are collaborating to present a
hands-on lab presentation designed for physicians and advanced practice professionals who provide
and document care for MMC inpatients and surgical outpatients. And the IAC (Immunization Action
Coalition) has collaborated with Med-IQ to develop two courses that offer CME credit for physicians
– one also provides CPE credits for pharmacists. Both courses relate to vaccinating adults with
chronic health conditions and are available online at no charge.
Dr. Joe Dreher offers another Mindfulness and Resilience Moment – this one focuses on the practice
and experience of generosity. We hope that you will be inspired by his insights.
Gratefully,
Joel Botler, M.D.
Chief Medical Officer
Cindy Boyack, M.D.
Medical Staff President
In This Issue
Infection Prevention Efforts Update
Clinical Documentation Improvement Labs April 6th
Mindfulness and Resilience Moment: Investigating Generosity
CME Opportunities: Adult Vaccines
Calendar
Infection Prevention Efforts Update
By D. Joshua Cutler, M.D., Vice President, MMC Quality and Safety
In late 2015, media coverage of Medicare’s Hospital Acquired Conditions (HAC) program suggested
a dangerously high infection rate at Maine Medical Center. While the report’s data was noteworthy
and resulted in a reduction of MMC’s Medicare reimbursement of about 1 percent, a more relevant
issue was the current state of our infection prevention efforts.
During the two-year period when performance was measured (January 2013 through December
2014), MMC produced sub-par quality in central line associated bloodstream infections (CLABSI) and
catheter associated urinary tract infections (CAUTI). There were 39 CLABSI in CY 2013 and 41 in CY
2014. However, in CY 2015 there were 26. The CLABSI SIR (standardized infection ratio, or
observed:expected) was 1.1 in 2013. In contrast, our most recent CLABSI SIR (July 2014 through June
2015) was 0.42, significantly below the national average of 0.56.
Similarly, the number of CAUTI at MMC dropped from 88 and 74 in 2013 and 2014 respectively, to
26 in CY 2015. In the four months ending January 31, 2016, 2 CAUTI occurred here. Clearly, CLABSI
and CAUTI rates at MMC are headed in the right direction.
Hospital acquired C. Diff and MRSA infections will be added to the list of measures in next year’s
HAC program report. Earlier this month, Consumer Reports published an analysis highlighting that C
Diff infection rates at MMC are among the lowest in the country. Only three other large teaching
hospitals have similar performance. Our most recent SIRs are 0.47 for C Diff and 0.33 for MRSA. In
fact, MMC’s MRSA and C Diff infection rates have been significantly lower than the national average
since 2013.
Our success in addressing these infection rates is due in large part to collaborative unit-based efforts
by nurses and providers. These efforts have focused on evidence-based prevention processes,
minimizing central line and urinary catheter use, excellent antibiotic stewardship, consistent
environmental cleaning, and disciplined hand hygiene. This progress is all the more impressive given
MMC’s high census and patient acuity levels over the past months.
We won’t know how these improvements will affect our comparative performance scores until the
HAC reporting lag fully catches up to the current period, which will take nearly two years. But we
can already see that our increased focus on infection prevention strategies is benefitting patients.
CAUTI at MMC
Calendar Year
2012
2013
2014
2015
Infections
135
88
74
26
CLABSI at MMC
Calendar Year
2012
2013
2014
2015
Infections
59
39
41
26
MRSA and C Diff at MMC
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Clinical Documentation Improvement Labs April 6th
Dr. Samir Haydar
Strong documentation supports regulatory requirements, improves outcome indicators, enhances
support for patient’s treatment plans, and reduces denials for lack of medical necessity. In an
electronic health record, clinical documentation can best be optimized by accurately maintaining
the patient’s problem list and performing problem oriented charting.
You are invited to attend one of two sessions for a Clinical Lab Presentation: on Wednesday, April 6
from 7 a.m. - 8 a.m., or from 4 p.m. – 5 p.m. at 7 Bramhall St. in Portland in Classroom #1.
MaineHealth Information Services and Clinical Documentation Improvement Departments are
collaborating to present a hands-on lab presentation designed for physicians and advanced practice
professionals who provide and document care for MMC inpatients and surgical outpatients.
MMC is accredited by the Maine Medical Association’s Committee on Continuing Medical Education
(CME) to physicians, and has designated this education activity for a maximum of 1.00 AMA PRA
Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their
participation in the activity.
Space is limited for each session. If you are interested, please contact Donna Morong at
[email protected] with your preferred session. Please include your legal name, unit/department
and email address. This program may also be offered to Physicians and Advanced Practice
Professional by request of their department contact. Every effort will be made to accommodate
department specific requests.
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Mindfulness and Resilience Moment: Investigating Generosity
By Joe Dreher, M.D.
MMC Medical Staff Provider Health and Resilience Committee
“The little things? The little moments? They aren't little.”
–Jon Kabat-Zinn
Mindfulness may serve us in many ways. One common means is through observing ourselves in our
daily lives and understanding where our feelings and choices lead us and perhaps how we may
become more skillful without berating ourselves in the process. One common first step is
considering our practice and experience of generosity.
Generosity is an effective form of self-help. It moves us into relationship with its collective ability to
help both others and ourselves, reduces isolation and fosters a sense of gratitude.
There is the story of an eminent therapist who, when meeting with a wealthy person struggling with
a sense of emptiness in their life, advised them to ‘go into a less fortunate neighborhood and help
someone.’ It worked. Those who are the recipient of a small act of kindness are more likely to then
help others. “Paying it forward” by performing some small generous act toward a stranger has been
shown to increase the givers level of happiness for the rest of the day.
Kind attention through greetings, smiles, holding doors open, making a meal, answering a question,
helping us accomplish a task, attentive listening, providing support and other momentary
interactions are the vast underpinning of each day. We receive and provide them ceaselessly with
little thought of how much they mean both to the giver and the receiver. Paying attention to these
acts warms the heart.
Investigating generosity may include considering our motivation in giving, how we view those we
give to, judging generosity (“value” verses the intention) and considering the balance between our
daily giving and receiving. See if you can notice in your head and heart how your feelings or
expectations impact your experience of generosity. Notice if multiple small acts of generosity have
a greater and more lasting impact on both sides.
Finally, are you generous with yourself? Health care workers often give more freely to others than
themselves. Where do you suppose this leads? How might you be more generous and
compassionate toward yourself?
Be well.
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CME Opportunities: Adult Vaccines
The IAC (Immunization Action Coalition) has collaborated with Med-IQ to develop two courses that
offer CME credit for physicians; one also provides CPE credits for pharmacists. Both courses relate to
vaccinating adults with chronic health conditions and are available online at no charge.


Vaccinating Adults With Chronic Disorders: Insights for the Primary Care Clinician A new
CME/CPE publication that offers frontline perspectives and practical strategies to help
primary care clinicians effectively address this growing public health concern.
Vaccinating Adults With Chronic Disorders: The Specialist’s Role A new, certified CME
publication that offers frontline perspectives and practical strategies regarding the critical
role specialists play in effective vaccination of patients with chronic disease.
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Calendar
MMC Medical Executive Committee Meeting Schedule for 2016
All meetings are held from 12-2 p.m. in the Dana Center Boardroom, and lunch will be served:
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March 18
April 15
May 20
June 17
July 15
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August 19
September 16
October 21
November 18
December 16
2016 Medical Staff Dinner
Please mark your calendar for the 2016 Medical Staff Dinners to be held from 5:30 p.m. – 7:30 p.m.
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April 6: Dana Center Lobby/Auditorium
September 28: East Tower Patio
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Story Ideas?
Your participation is essential to making The Scope a dynamic and sustainable publication. Please
submit articles of 250-300 words to [email protected]. Include practitioner’s byline with title and
appropriate contact for further information. We publish two times each month.
To view past issues, visit www.mmc.org/TheScope.
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Medical Staff Value, Mission, and Vision Statements
Value Statement
The Medical Staff of Maine Medical Center values both individuality and collaboration. We will
continually pursue higher value health care. We embrace a culture of curiosity and life-long
learning. We are partners with Maine Medical Center, and we mirror its values of compassion,
service, integrity, respect, and stewardship.
Mission Statement
The Mission of the Medical Staff of Maine Medical Center is to provide affordable, high-quality
health care to our community. We teach future health care providers and develop innovative ways
to improve the health of our community. In partnership with the Medical Center, we proudly accept
our responsibility as one of Maine’s leaders in patient care, education, and research.
Vision Statement
The Medical Staff of Maine Medical Center will be the driving force within Maine Medical Center
leading the way to making Maine the healthiest state in the nation.
A Compact Between Maine Medical Center and Its Medical Staff
Peer Support
for the MMC Medical Staff
[email protected]
Physician leader: Christine Irish, MD
Confidential * One-on-One * Peer Support
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www.mmc.org
22 Bramhall Street, Portland, ME 04102 | (207) 662-0111
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