Stephen Grubbs, M.D.

Christiana Care medical oncologist Stephen S. Grubbs, M.D., has been elected to a three-year term on the board of directors of the American Society of Clinical Oncology (ASCO), the world’s leading professional organization representing physicians who care for people with cancer.

Dr. Grubbs, managing partner of Medical Oncology Hematology Consultants at Christiana Care’s Helen F. Graham Cancer Center, was elected to a community oncology seat on the board. The ASCO position enables Dr. Grubbs to bring the perspective of the community oncologist to ASCO deliberations. He begins his term on June 1, 2012.

ASCO is governed by a 19-member board of directors who oversee the organization’s activities and strategic direction. In addition to the president and treasurer, ASCO’s comprises oncology leaders elected to represent one of five distinct areas, including the community oncology seat, within the oncology field.

“This is a tremendous accomplishment for Dr. Grubbs and the Helen F. Graham Cancer Center,” says Nicholas J. Petrelli, M.D., Bank of America Endowed medical director of the Helen F. Graham Cancer Center. “Dr. Grubbs’ vision and leadership have been instrumental in helping the Helen F. Graham Cancer Center at Christiana Care become a national role model for cancer care.”

An accomplished researcher and author of many scientific and clinical papers, Dr. Grubbs also serves as principal investigator for Christiana Care’s Community Clinical Oncology Program. He was recently elected to the board of directors and executive committee of the newly formed Alliance of Clinical Trials in Oncology. The Alliance merges three National Cancer Institute funded research cooperative groups into one, leveraging their talents and resources to bring the latest cancer control, prevention and treatment clinical trials more quickly to patients at community cancer centers.

A graduate of Thomas Jefferson Medical College in 1979, Dr. Grubbs completed his residency and internship in internal medicine at Christiana Care from 1979 to 1982. He finished a hematology-oncology fellowship at Dartmouth-Hitchcock Medical Center in 1984.

During his distinguished career at Christiana Care and in private practice, Dr. Grubbs has received a number of clinical and academic appointments and honors. He received the David King Clinical Scientist Award from the Association of Community Cancer Centers in 2007, and the National Cancer Institute recognized him with the Director’s Service Award in July 2011 for advising the NCI director on the Clinical Trials Advisory Committee.

A clinical assistant professor of medicine at Thomas Jefferson University Medical School and past president of the Medical Society of Delaware, Dr. Grubbs serves on the Delaware Cancer Consortium’s Advisory Council and chairs its Early Detection and Prevention Subcommittee.

With more than 30,000 members, ASCO is committed to improving cancer care through scientific meetings, educational programs and peer-reviewed journals. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation, which funds ground-breaking research and programs that make a tangible difference in the lives of people with cancer.

The Avon Breast Health Outreach Program has awarded a $55,000 one-year grant to Christiana Care Health System to increase awareness of the life-saving benefits of early detection of breast cancer. It is the eleventh year that the program has received funding from the Avon Foundation for Women to support its work on this important health issue and in recognition of the program’s excellence.

Helping Hands for Breast Health at Christiana Care’s Helen F. Graham Cancer Center will educate New Castle County area women and refer them to low-cost or free mammograms and clinical breast exams in their own communities, and enroll them into the annual reminder system and have the Avon outreach coordinator assist them to eliminate barriers that may interfere with them completing their breast screening. The coordinator will assist with finding transportation or financial resources through state and local funds to pay for the services. The vital program will also collaborate with the local Avon representatives through the Pink Tool Kit project. The Avon Breast Screening Coordinator (AOC), Kristin Barnes has worked with local District Manager- Deb Wilson to educate local reps about breast health and encourage them to provide information to their clients.

Since January 2002, the Helping Hands for Breast Health Program at Christiana Care has reached more than 20,000 women with information about the importance of early detection of breast cancer and has referred more than 7,700 women for mammograms and clinical breast exams.

Breast cancer is the most common form of cancer in women in the United States, and the leading single cause of death overall in women between the ages of 40 and 55. According to the American Cancer Society, 740 new cases of breast cancer will be detected in {Delaware} this year and 120 lives will be lost. Nationwide, there is a new diagnosis every three minutes and a death from breast cancer every 14 minutes. While advances have been made in prevention, diagnosis, treatment and cure, early detection still affords the best opportunity for successful treatment. Programs such as Helping Hands help ensure that all women have access to early detection information and options, even poor and medically underserved women.

“We are proud that the Avon Foundation for Women shares our mission and has chosen to support our program again this year. With these funds we will be able to continue our partnerships with the Avon representatives, assist women through the work of our screening navigator and staff and continue our reminder system. All of these components of the program make a difference to change women’s behavior and incorporate breast health in their lives.” says Nora C. Katurakes, Manager of the Community Health Outreach Program for Christiana Care.

“These programs are dedicated to educating underserved women about breast cancer and linking them to early detection screening services.”

The Avon Foundation for Women and Breast Cancer Crusade

The Avon Foundation for Women, an accredited 501(c)(3) public charity, was founded in 1955 to improve the lives of women and today is the world’s largest corporate-affiliated philanthropy focused on issues that matter most to women. The Avon Breast Cancer Crusade, which observes its 20th anniversary in 2012, has placed Avon at the forefront of the fight against breast cancer; today, Avon is the leading corporate supporter of the cause globally. In the 20 years since the Crusade’s launch, Avon breast cancer programs in 58 countries have donated more than $740 million for research and advancing access to care, regardless of a person’s ability to pay. Avon raises funds for the Crusade through the sale of Avon “Pink Ribbon” products, and through events and walks, such as the U.S. Avon Walk for Breast Cancer series, which is the Foundation’s largest fund-raising source.

The Avon Breast Health Outreach Program

The Avon Breast Health Outreach Program is administered by Cicatelli Associates Inc. to support community-based, non-profit breast health programs across the country. The Fund’s National Advisory Board selected Helping Hands for Breast Health at Christiana Care as one of 120 new grant recipients nationwide in the 2012 cycle of Avon Breast Health Outreach Program grants. These organizations were chosen based on their ability to effectively reach women, particularly minority, low-income, and older women, who are often medically underserved.

For more Information

For more information on Helping Hand at Christiana Care please call Nora Katurakes at 302-623-4628. For more information about breast cancer, contact the American Cancer Society at 1-800-ACS-2345 or www.cancer.org, or the National Cancer Institute at 1-800-4-CANCER or www.cancer.gov.

To learn more about the Avon Foundation for Women, call 1-866-505-AVON or visit www.avonfoundation.org, where you can access free printable Breast Health Resource Guides in English and Spanish. For information or to register or support the Avon Walk for Breast Cancer events, visit www.avonwalk.org or call 1-888-540-WALK.

In “Using Anticoagulants to Steer Clear of Clots,” William Pezzotti, RN, and Melissa Freuler, RN, both nurses in the Emergency Department at Christiana Hospital, describe blood thinners used to prevent blood clots in patients, the nursing care of patients on blood thinner and the emergency treatment of patients who develop bleeding complications from these drugs. They also cover the management of patients who require clotting due to a traumatic injury or surgery.

“It is very important for nurses to know how and why blood clots form, because assessing, recognizing and treating a clot can save a patient’s life,” says Pezzotti.

James W. Blasetto, M.D., chairman of the AstraZeneca HealthCare Foundation, presents a check to Kathleen McNicholas, M.D., medical director of the Department of Cardiac Surgery at Christiana Care, and Michael Rosenthal, M.D., chair of the Department of Family and Community Medicine at Christiana Care.

The AstraZeneca HealthCare Foundation awarded a grant of more than $152,000 to Christiana Care Health System’s Cardiovascular Outreach Prevention Program Tuesday, Feb. 14 (Valentine’s Day), at Paul M. Hodgson Vocational Technical High School in Newark.

Christiana Care’s program is targeted towards underserved, low-income African-American teens and adult women. It works by engaging teens to increase both their knowledge and confidence in their ability to make healthy lifestyle changes, as well as to teach them skills to improve the heart health of their mother or another important adult female in their lives.

“We believe very strongly that if there is a health partnership between family members they’ll do a lot better and we’ll do a lot better in helping them in our health system and in our region,” said Michael Rosenthal, M.D., chair of the Department of Family & Community Medicine at Christiana Care Health System. “We know a lot of family care is centered through the woman in the family, and this is a successful way to reach out to them.”

Christiana Care was one of only 20 grant winners nationwide for the AstraZeneca HealthCare Foundation’s Connections for Cardiovascular Health, which was launched in 2010 and awards grants of $150,000 and up to U.S.-based nonprofits that are performing innovative work in the field of cardiovascular health.

With the grant, Christiana Care’s Cardiovascular Outreach Prevention Program will enhance its existing health education programs. Those include No Heart Left Behind (heart health education for teens and adult participants) and Camp FRESH (educate urban teens on healthy lifestyles). Nemours Health and Prevention Services will provide training for the new cognitive-behavioral component, COPE/TEEN (Creating Opportunities for Personal Empowerment/Thinking, Emotions, Exercise, Nutrition). COPE/TEEN provides health education and teaches cognitive-behavior skills to support adolescents’ beliefs about their ability to perform healthy lifestyle behaviors. This program also has teens engage their mother or another adult female in their life to assist in improving her heart health.

“We are so thrilled that AstraZeneca has found value in this,” said Kathleen McNicholas, M.D., the medical director in the Department of Cardiac Surgery at Christiana Care. “This program works, and we will continue to prove it works.”

Christiana Care’s program is an innovative way to improve cardiovascular health in New Castle County among females, said James W. Blasetto, M.D., chairman of the AstraZeneca HealthCare Foundation.

“This program is aimed at a low-income teens and women and is responding to the urgent, unmet needs in the community,” Blasetto said. “On behalf of the AstraZeneca HealthCare Foundation, we want to thank Christiana Care for all the work they have done.”

The announcement of the grant was covered by WDEL, 6ABC Action News and The News Journal. State Sen. Bethany Hall-Long—a Christiana Care trustee—and State Rep. Earl Jaques also attended the event.

Ambrosia Mondoa and her daughter Matanda Mondoa, a 19-year-old freshman student at Bryn Mawr College, spoke at the event. Ambrosia and Matanda have been through the Cardiovascular Outreach Prevention Program, and it has helped them make better lifestyle decisions.

“I’ve lost 40 pounds since I’ve been through the program,” said Ambrosia Mondoa, who lives in Bear. “I am healthier and I feel healthier. I am thankful that this program exists.”

Photo gallery: AstraZeneca awards $152,000 to Christiana Care Cardiovascular Outreach Prevention Program

Teresa Alvarez hugs her daughter, Sharon Gomez, during a chemotherapy session at the Helen F. Graham Cancer Center.

Teresa Alvarez is a pioneer Promotora, a promoter of health education and a founding member of the volunteers trained at Christiana Care to reach out to other women in the Latina community to advocate for cancer screenings.

It is a cause close to her heart. Her daughter, Sharon Gomez, was a Community Health Outreach and Education coordinator at Christiana Care, and recruited her mom to help with the Promotoras initiative.

“One of the things we talk about to the Latinas is the importance of doing a monthly self breast exam,” says Alvarez, a native of Puerto Rico who lives in Wilmington.

She followed that advice herself, doing self exams in addition to getting an annual mammogram.

Last September, she discovered a lump on her clavicle. The diagnosis: lymphoma, a type of cancer that begins in immune system cells called lymphocytes.

Alvarez was frightened. Her mother died from breast cancer. She also lost a brother to lung cancer.

But she knew from her Promotoras training that a cancer diagnosis is not a death sentence. She began treatment immediately at the Helen F. Graham Cancer Center at Christiana Care.

On a recent afternoon, Alvarez, 71, arrived for her sixth and final round of chemotherapy. Gomez, now a Spanish interpreter in the Emergency Department, interpreted for her mother as she talked about her work with the Promotoras.

“My mother tells the women that if they take care of themselves they will have a better quality of life and will see their children grow,” Gomez says.

“The Promotoras have played an important role in Christiana Care’s mission of bringing screenings and education to underserved communities,” says Nora Katurakes, manager, Community Health Outreach and Education.

“With the training we give them, they go back to their communities and raise awareness about the importance of cancer screenings and preventive care,” she says.

Among Hispanic women, breast cancer is the leading cause of cancer death, according to the American Cancer Society. Hispanic women are 20 percent more likely to die from breast cancer than non-Hispanic white women diagnosed at the same age, often because the cancer is diagnosed at a later stage, according to ACS Cancer Facts.

“I was able to get through to the women with love and with patience—and by sitting them down a couple of times and persisting,” Alvarez says. “I tell them that if you are able to detect cancer early there is a very good chance you can cure it.”

At Helen F. Graham, she receives highly skilled and compassionate care. Her care is seamlessly coordinated by a nurse navigator, who schedules treatments, tests and doctor’s appointments.

“I have wonderful doctors and nurses, very well trained, as well as kind and sympathetic,” she says. “Everything I need is right here.”

John Otto, O.D.

John Otto, O.D., recently became board certified in optometry. This noteworthy achievement makes Dr. Otto the first ever board-certified optometrist in Delaware and currently the only optometrist in the state to receive certification by the American Board of Optometry. The ABO’s process of board certification and maintenance of certification demonstrates the dedication to providing exceptional patient care through a rigorous, voluntary commitment to lifelong learning.

Dr. Otto practices as a member of Christiana Care’s Eye Care Department.

A chronic disease, pulmonary hypertension affects people of all ages and ethnic backgrounds. Raising awareness in the community and among medical professionals is key to earlier diagnosis and treatment.

“Taking care of people who have pulmonary hypertension requires special expertise, from coordinating their complex medical needs and finding the best drugs to manage their breathing and heart troubles, to obtaining insurance authorization for drug therapies,” says Pulmonary Arterial Hypertension Nurse Navigator Sharon Jones, RN, MSN, CCM.

The pulmonary hypertension program at Christiana Care takes a multidisciplinary approach to treatment, bringing together a pulmonologist, a nurse practitioner, a clinical nurse specialist, a nurse navigator and a clinical pharmacist to provide specialized care for inpatient and outpatient adults. Working together, the team shapes and continually refines an individual plan of care.

In recent years, many new medical treatments have emerged to help patients better manage their symptoms. Pulmonologist Gerald O’Brien, M.D., began treating patients with pulmonary hypertension 19 years ago when he was the director of the lung transplant team at Temple University Hospital.

“In the beginning, there were few treatment options, but now we have medications in all forms—pills, intravenous and subcutaneous infusions, and even inhaled therapies that we can offer. Most patients require triple therapy for the best outcomes, and we strive to reduce the progression of the disease and improve the functional class of our patients,” Dr. O’Brien says.

The outpatient pulmonary hypertension clinic at Christiana Hospital is part of the Center for Heart and Vascular Health. Clinic patients have access to the state-of-the-art cardiac catheterization lab, non-invasive cardiac testing, cardiopulmonary stress testing, pulmonary function lab testing and many other services.

“When patients are admitted, the team works closely with nursing to ensure continuity of care,” Jones says.

Patients on intravenous, subcutaneous or inhaled therapy must be on 3D, the pulmonary stepdown unit, under the care of specially trained nurses. Every nurse on 3D attends an annual pulmonary hypertension workshop developed by the unit’s education council. The workshop was submitted for a Christiana Care Focus on Excellence award, representing the success and dedication of the staff in caring for this unique patient population.

Chanel Etty, a 3D nurse who has taken care of pulmonary hypertension patients for five years, takes pride in having these specialized skills and has seen an increase in pulmonary hypertension patients during this time.

“I find it very rewarding to be a part of a select group of nurses that have expertise in this area,” Etty says. Other program features include a monthly patient-led support group and access to new or investigational treatments through participation in industry-sponsored clinical trials.

Comparing pulmonary hypertension and essential hypertension

Content Delaware profiled Christiana Care’s Hip FIT (Fracture Intervention Team), a multi-disciplinary team led by the Department of Orthopaedic Surgery. The team seeks to increase awareness of the risk factors that lead to fragility fractures, in order to better coordinate prevention and treatment services and to significantly reduce the number of injuries of this kind in Delaware.

U.S. Rep. John Carney announced the Drug Shortage Prevention Act, which would reduce the risk of drug shortages that today create difficult challenges for doctors trying to deliver needed medical care.

U.S. Rep. John Carney announced HR 3839—The Drug Shortage Prevention Act—designed to address prescription drug shortages, on Jan. 31 at Christiana Care’s Helen F. Graham Cancer Center.

Nicholas Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center, Stephen Grubbs, M.D., a practicing oncologist and the managing partner of Medical Oncology Hematology Consultants, P.A., located at the Graham Cancer Center, as well as Terri Corbo, vice president of Christiana Care Pharmacy Services, joined Carney at the press conference.

“Since 2005, the number of drug shortages in the United States has quadrupled, and cancer patients have been disproportionately impacted by this troubling trend,” Carney said. “We must ensure that Americans have access to the critical drugs they need to stay healthy and fight back against deadly diseases. The Drug Shortage Prevention Act brings more efficiency to the manufacturing and distribution processes and requires the FDA to take action to prevent drug shortage problems before they begin impacting patients.”

Carney addressed a packed auditorium of oncologists, pharmacists, nurses and social workers at the Helen F. Graham Cancer Center. State dignitaries such as Rita Landgraf, secretary of the Delaware Department of Health and Social Services, and Bettina Riveros, chair of the Delaware Health Care Commission, also were on hand.

Carney’s legislation mandates an expedited review of drugs vulnerable to shortage in order to prevent shortages in the first place. The bill, which is co-sponsored by Rep. Larry Bucshon (R-IN), also requires the FDA to use a more refined regulatory process that addresses manufacturing problems without instigating drug shortages. The bill streamlines communications between the FDA, manufacturers, distributors, providers and patients to ensure that all parties have the information they need to act proactively to prevent shortages from occurring. The Drug Shortage Prevention Act is endorsed by The American Society of Clinical Oncology, the American Society for Parenteral and Enteral Nutrition, AstraZeneca, and the Hematology/Oncology Pharmacy Association.

“My colleagues and their patients face major issues with prescription drug shortages, not only here in the state of Delaware, but across the United States,” said Dr. Petrelli. “My major concern is for the drug shortages that my colleagues have for their patients. In my experience, John Carney has made health care one of his top priorities and has helped us move forward with some major results.”

Six years ago, there were 61 different drug shortages. Last year, there were more than 230. Cancer, anesthesia and nutrition medicines, which are delivered intravenously rather than in pill form and have a complex, time-consuming, and highly precise manufacturing process, are overwhelmingly affected by these shortages.

“With one drug we even have had to figure out a rationing system,” added Dr. Grubbs. “We’ve been finding ways to get through this challenge, but it has been a struggle.”

Many of these drugs have only one or two manufacturers in the market, so when a manufacturing problem occurs, it can quickly cause a shortage.

“Inadequate medication supplies force the use of alternate medication that can increase the risk of side effects and sometimes is not as effective,” said Terri Corbo, vice president of Christiana Care Pharmacy Services. “The potential risk to patients, whether direct or indirect, is significant.”

Photo gallery: Drug Shortage Prevention Act press conference

Sen. Tom Carper was among those present to celebrate Delaware's success in enrolling new mothers and mothers-to-be in text4baby, a convenient way of communicating health and safety information to moms via mobile phone.

Participating Delaware partners who helped enroll women in text4baby, a free text-messaging service of the National Healthy Mothers, Healthy Babies Coalition, celebrated their top finish in the 2011 national text4baby state enrollment contest.

Text4baby provides a fast and convenient way of communicating health and safety information via cell phones during pregnancy and during the baby’s first year of life. By simply texting “BABY” (or “BEBE” for information in Spanish) to 511411, women can register to receive weekly text messages that are in sync with key times based on their baby’s due date and at significant points throughout the baby’s first year.

The tips and messages have been developed in collaboration with government and nonprofit health experts.

At the Jan. 30 celebration event at the John H. Ammon Medical Education Center, Sen. Tom Carper (D-Delaware) described how seamlessly the Delaware organizations worked together to help the First State take first place. Those partners included Christiana Care Health System’s Obstretrics and Gynecology Department, the University of Delaware’s Center for Disabilities Studies and the Delaware Department of Health and Social Services.

Key Delaware leaders who attended the conference included Rita Landgraf, Secretary of Delaware’s Department of Health and Social Services, Karyl Rattay, M.D., director of Delaware’s Division of Public Health, Lolita Lopez, president and CEO of Westside Family Healthcare and Rosa Rivera, president and CEO of Henrietta Johnson Medical Center. Both Westside and Henrietta are federally-qualified health centers.

Over the course of the contest, partners in Delaware used diverse outreach methods, combining media, a state-wide contest and targeted distribution of text4baby materials to every obstetrician in Delaware. These collective efforts helped text4baby register 4.5 percent of eligible moms during the contest period, nearly doubling the number of participants in the state to a total of 979 users as of October 2011.

“Our patients truly value the text4baby services,” said Mary Stirparo, the practice manager at Christiana Hospital’s Department of Obstetrics. “One patient, after receiving a text sought care at an Ob/Gyn unit and that all came out of text4baby. Thanks to text4baby, this patient ended up giving birth to a healthy baby.”

Photo gallery: text4baby success

Janice E. Nevin, M.D., MPH

Christiana Care Chief Medical Officer Janice Nevin, M.D., was interviewed about the importance of multidisciplinary teams and a patient-centered approach to performance improvement in a Becker’s Hospital Review Q&A.

Adewale Troutman, M.D., president-elect of the American Public Health Association, stressed the importance of creating sustainable improvements in public health at the Delaware Health Sciences Alliance's inaugural Global Health Symposium. The symposium reflects a growing interest in the topic of global health at Christiana Care and around the state.

You’re on a riverbank and you start to see babies floating by. What do you do?

You jump in and save the babies. But to make a sustainable difference, you also need to look upriver to see who’s throwing the babies in.

That is the challenge of improving global health, said Adewale Troutman, M.D., president-elect of the American Public Health Association, in his keynote address to the first Global Health Symposium of the Delaware Health Sciences Alliance, Feb. 4 in the Ammon Center.

“We spend so much of our time pulling babies out of the water,’’ he said. For instance, “we spend time screening for hypertension so we can treat people. We don’t look to see why they’re developing hypertension.’’

The Global Health Symposium attracted about 60 attendees from all four of the alliance partners—Thomas Jefferson University, Nemours, the University of Delaware and Christiana Care—including medical and undergraduate students, residents, nurses, physicians, researchers and other professionals from disciplines as varied as anthropology, public health, psychology and library science. What unites them is a common interest in improving lives by eliminating health inequities around the world.

“Global health issues affect the most vulnerable,’’ said Omar Khan, M.D., symposium chair. “At the broadest and most fundamental level, our aim is to improve the health of all people in the world.’’

The symposium is part of a new effort to provide a global-health curriculum at Christiana Care. It comes in response to what speakers at the symposium and in prior interviews described as a burgeoning desire for education in international health issues.

“There’s very high interest in global health, particularly in medical students who come looking for residencies,’’ said John Donnelly, who interviews many residency candidates. “They understand the mission of it. They understand our jobs as physicians should include looking at people around the world that don’t have what we have.’’

That interest is what led Karla Testa, M.D., a medical pediatrics resident, and two other residents, Christopher Prater, M.D., and Audrey Merriam, M.D., to create a survey aimed at gauging residents’ demand for a global-health curriculum track at Christiana Care. Of the 105 who responded, 78 percent said it’s an important option and 55 percent said they’d be interested in participating.

Encouraged, the team worked with Dr. Donnelly, Dr. Khan and Susan Thompson, D.O., to create the curriculum that launched last summer. The two-year program includes 11 faculty or guest lectures each year, two journal clubs and grand rounds. On March 1, Cliff O’Callahan, M.D., faculty of Yale Pediatrics Global Health Track and director of Nurseries at Middlesex Hospital, Middletown, Conn., will present grand rounds at the Ammon Center auditorium at 8 a.m. The topic: “Global Development Goals (and the Role of the Individual in Changing the World.)”

The lectures are open to all and have attracted participation from all parts of the Delaware Health Sciences Alliance.

January’s talk on helminths and parasites (alliteratively titled “Pick-pocketed by Pinworm: the Burden of Parasites in the Developing World) by Wesley Emmons, M.D., drew a dozen or so listeners, including residents, attending physicians and nurses. Kevin Smallwood, a physician’s assistant in the audience, said he was there because he’s going on a medical mission to Honduras in March. “I thought I could learn more about what I might be seeing there,’’ Smallwood said.

Education, not only about specific diseases but also about cultures and what Dr. Troutman called “the causes of the causes’’ of health problems—the social determinants that affect individuals and communities, such as poverty, injustice, powerlessness—is often missing from well-meaning health efforts. Dr. Troutman, who has worked in many countries with the World Health Organization, in academia and as a local health officer, said he has seen “people who are doing research on people they know nothing about. They drop in, do research and leave, leaving nothing for the community.’’

That is what Dr. Khan and colleagues say they hope to avoid. To begin to tackle the enormous problems of the developing world in ways that are sustainable will require education, collaboration among medical and academic institutions and lasting partnerships with the people in communities and countries where the work is being done.

“We don’t want to say, ‘here’s a disaster, here’s your stethoscope. Go solve problems,’’’ Khan said. “You can’t be part of the solution without knowing what the problems are.’’

Global Health Curriculum upcoming lectures

All talks are at 5:30 p.m. in the John H. Ammon Medical Education Center unless otherwise noted.

• Feb. 23:  ”Tuberculosis,” Anand Panwalker, M.D., Infectious Disease. Room 14.
• March 1: “Global Development Goals (and the Role of the Individual in Changing the World,” Cliff O’Callahan, M.D., Yale/Middlesex. Main auditorium, 8 a.m.
• March 22: “Child Health,” Amanda Kay, M.D., Pediatrics. A.I. DuPont conference room, 3rd floor, 6:30 p.m.
• April 19: “Health Systems and the WHO,” Henry Benarey Ph.D., M.Sc. (Hon), World Health Organization. Room 14.
• May 17: TBA.
• June 14: “Global Health Careers,” Laura Eloyan, MBA, Global Health Specialist at Centers for Disease Control. Room 14.

Photo gallery: Global Health Symposium

Jonathan Blum, deputy administrator and director for the Center of Medicare at the U.S. Centers for Medicare and Medicaid Services, toured Christiana Care and spoke about accountable care organizations, which are a new form of payment and care delivery model that is being tested as a way to increase quality and reduce cost in health care.

Christiana Care hosted Jonathan Blum, deputy administrator and director for the Center of Medicare at the U.S. Centers for Medicare and Medicaid Services (CMS), to speak about accountable care organizations on Monday, Jan. 30.

Blum is responsible for overseeing the regulation and payment of Medicare fee-for-service providers, privately-administrated Medicare health plans, and the Medicare prescription drug program. He was invited to speak at the John H. Ammon Medical Education Center by U.S. Sen. Tom Carper. Rita Landgraf, secretary of Delaware Health and Social Services, Delaware State Rep. Michael Barbieri and Bettina Riveros, Gov. Jack Markell’s policy adviser on health care, also were in attendance.

Blum also met with Christiana Care’s senior leaders for lunch and was given a tour of Christiana Hospital from the perspective of a patient with cardiac problems. Blum visited the trauma bays at the Emergency Department, followed by entry to the Heart & Vascular Interventional Services on the second floor, where cardiac catheterization would be performed.

“We wanted to show him how we would provide care for a patient during the tour, rather than simply just showing him the facilities,” said Janice Nevin, M.D., the chief medical officer for Christiana Care. “Mr. Blum was very interested in understanding what the providers are experiencing in this current environment.”

Upon completion of the tour, Blum gave an overview on accountable care organizations to about 40 Delaware health care stakeholders—comprised largely of leaders of several Delaware health systems and federally-qualified health centers.

An accountable care organization (ACO) is a type of payment and delivery reform model that links provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. A group of coordinated health care providers—which can include doctors, hospitals, nursing homes—form an ACO, which then provides care to the group of patients. Thirty-two health systems have been selected by CMS to participate as pioneer accountable care organizations. Blum noted that these systems were able to qualify because they already have experience in population health, pay-for-performance and risk-based reimbursement.

“What we heard underscores the message that if we are going to be able to position ourselves for the future, we need to continue to design and experiment with projects built on the principles of an accountable care organization,” Nevin said.

Photo gallery: Jonathan Blum visits Christiana Care

Volunteer massage therapist Ellyn Hutton massages cancer patient Edward Gebhardt at the Helen F. Graham Cancer Center. During the month-long program, 37 patients and 17 caregivers received free therapeutic massages.

When the Delaware Chapter of the American Massage Therapy Association reached out to the Helen F. Graham Cancer Center with an offer to provide volunteer massage therapy to oncology patients and their caregivers, the Mind, Body, & Spirit Wellness program did some massaging of its own to make sure the program succeeded.

“We connected with people in Infection Control, Compensation, and Volunteer Services,” says Susan Guerino, RN, nurse navigator for the Mind, Body, Spirit Wellness Program. “The AMTA chapter found therapists with additional training in oncology massage therapy who wanted to volunteer.” Then Volunteer & Student Services Administration coordinated background checks for proof of licensure, additional training in oncology massage and other details, including proof of tuberculosis screening and influenza vaccine. The process took about six months. The upshot was clearance for seven volunteer massage therapists to begin offering services.

The program began Oct. 24, 2011, and continued through Nov. 11, 2011, performing massages in the Cancer Care Management Department. A total of 55 appointments were scheduled, of which 37 were oncology patients and 17 were caregivers. Massage appointments varied in length from 30 to 45 minutes.

“This was a good collaborative effort that greatly benefited our patients,” said Nicholas Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center. “Patients overwhelmingly expressed relief in the amount of stress and pain they experienced.”

“We greatly appreciate the generosity of the volunteers not only for their service but for their care and compassion for our patients,” said Cynthia Waddington, RN. “It allowed us to offer a healing modality that our patients are very interested in.”

Employed physician groups play an important role in Christiana Care's emphasis on customer satisfaction and efficiency, safety and care. The Medical Group of Christiana Care operates practices throughout the region, including the Smyrna Family Practice at the Health and Wellness Center in Smyrna, Del.

At the Medical Group of Christiana Care, doctors have different specialties and varying levels of experience, but a single cohesive culture. Owned by Christiana Care Health System, the Medical Group is part of a sweeping, dynamic vision for care that is excellent, consistent, convenient and cost effective.

“We work together as a multispecialty group that utilizes best practices and measurable results to deliver safe, accessible, quality, health care to patients,” says Alan Greenglass, M.D., senior vice president and medical director of the Medical Group.

A growing trend, employed physician groups are an important part of health care’s evolution into a service that is focused on customer satisfaction and efficiency, in addition to safety and care. Of the 1,400 doctors who practice at Christiana Care, 300 are employed by the health system. About 150 physicians, nurse practitioners and physician assistants are involved directly in the care of patients.

In addition to 16 primary care practices, there are a number of specialties under the Medical Group umbrella. They include: dermatology, eye care, obstetrics and gynecology, pediatrics, rheumatology and urogynecology.

The Medical Group also encompasses the Center for Diabetes and Metabolic Diseases, Christiana Care Hospitalist Partners, the Delaware Center for Fetal & Maternal Medicine, HIV/AIDS care, a kidney transplant program and Surgical & Critical Care Specialists, the state’s only Level 1 trauma center.

The HealthCare Center at Christiana, across the street from the Christiana Hospital campus, provides ready access to doctors’ offices, a pharmacy, radiology and physical therapy. “The practice is very convenient for the patient,” says Medical Group executive director Robert Bycer.

In a time of reduced fees for Medicare and other reforms, administrating a practice is proving increasingly cumbersome for many care providers. The number of doctor searches for hospital employment doubled from 23 percent in 2005 to 56 percent in 2010, according to Merritt Hawkins, a physician job search firm. According to an Accenture study, the rate of hospital-employed physicians will grow by 5 percent each year during the next three years.

Christiana Care acquired its first practice, a medical group in Salem County, N.J., in the early 1990s. But it wasn’t until 2005 that a strategy for a group practice model began to take shape. In addition to salary, Medical Group benefits include paid vacation, health insurance, a generous retirement plan and a week each year for continuing medical education. There also are rich opportunities to collaborate and contribute to a shared vision.

“They’ve made a conscious decision to become part of a larger organization,” Bycer says. “We’re not in our silos any more.”

The Medical Group also provides clear expectations for both providers and their patients, who can count on regular office hours and standardized operations. An operating council meets monthly to share concerns and ideas.

“Providers and patients benefit from consistency in billing and other procedures,” Dr. Greenglass says. “The same rules apply in Middletown as in New Castle.” With practices located in Delaware, Pennsylvania and South Jersey, patients have greater flexibility. Because providers in the Medical Group share access to electronic health records, it is easier for doctors to collaborate. Tests and other procedures aren’t duplicated.

“If you can’t get to your doctor in Hockessin, the doctor in Smyrna has access to your records,” Bycer says. “He can take care of you then report back to your regular doctor.”

A new clinical ladder at Christiana Care provides nurses with additional opportunities for professional advancement while allowing them to continue caring for patients at the bedside.

Two new tiers on Nursing’s clinical ladder at Christiana Care offer the health system’s almost 3,000 registered nurses greater opportunity for professional advancement, while ensuring an even safer clinical environment for patients.

On Dec. 11, the ladder expanded to four tiers from two, adding rungs for Level I novice/advanced beginner RNs, as well as a Level IV for expert RNs and empowering nurses to chart their own career advancement paths. For RNs wishing to pursue graduate degrees, certification or clinical specialty and yet remain at the bedside, the new Levels III and IV offer greater opportunity for recognition and compensation without needing to leave direct patient care for other positions.

“Until now, the only option for recognition or promotion was to move into administration, research or educational positions,” explains Dot Fowler, MSN, RN, BC, APN, administrative adviser for Nursing’s Professional Advancement Council. By offering Career Advancement of RN Excellence through Synergy (CARES), we now have the transformative opportunity to further develop and reward nurses who elect to apply their advanced knowledge and experience at the bedside.”

The Christiana Care Nursing Care Delivery Model is based on the American Association of Critical Care Nurses Synergy Model, which recognizes experience and the unique relationship between nurses and patients. Research reveals that each additional year of nursing experience on a clinical unit corresponds to five fewer patient deaths.

The extended ladder is the result of years of planning by more than 150 direct-care nurses representing their colleagues on the Professional Advancement Council (formerly the RNII Council), explains former council chair Crystal Pollock, RNII, C.

Dannette Mitchell, BSN, RN, CCRN, one of the longest-serving Professional Advancement Council representatives, explains that the expansion of Nursing’s clinical ladder validates the work of the nurse at the bedside, rewarding years of experience, knowledge and clinical expertise. “It offers those of us who love our work at the bedside to remain where our professional passion is, while giving us something to strive for,” Mitchell said. She said that the involvement of nurses on the council was integral to the successful launch of the expanded ladder. “We are the nurses at the bedside— on the front lines—representing our fellow workers, the nurses this ladder will affect.”

Marsha Babb, MS, BSN, RN, CNOR, who currently chairs Professional Advancement Council and was among the first Christiana Care nurses to apply for the RNII position back in 2002, describes the new ladder as “a transformational change in nursing.” Her motivation for more than six years on the council to help bring the expansion to fruition is fundamental as she speaks on behalf of her nursing colleagues. “We are worth it.”

Expanded clinical ladder

Level I is a six-month first step on the ladder for all newly hired RNs with less than six months experience. Its focus is on training, mentoring and nursing excellence.

Nurses at Level I soon advance to Level II/Competent RN, where they may choose to remain or to continue their climb to higher levels.

Level III marks proficiency and is most closely aligned to what has been the RNII designation to date.

Level III/Proficient RNs must have: at least five years of professional nursing experience, with two of those years in the current clinical specialty; a BSN or active enrollment in a BSN program; professional certification; and other qualifications.

In addition to the Level III requirements, Level IV/Expert RNs (available this spring), must either hold an MSN or be actively enrolled in a master’s program. These nurses must also chair or lead a shared decision making council or task force or demonstrate other system-based leadership experience.

Level IV RNs also hold leadership positions on local or national professional organizations and in community-based volunteer capacities.

James Philhower is among the first recipients of a new stent system undergoing clinical trials at Christiana Care and a handful of other sites in the United States and Japan. The new technology is designed to treat vascular disease in the legs, a painful condition that affects 8 million Americans.

Christiana Care is among the first health care organizations in the U.S. to participate in a unique international medical trial involving a new stent system developed in Japan for treating peripheral artery disease (PAD). The occlusive/stenotic peripheral artery revascularization study, dubbed “OSPREY,” will test a new, more flexible stent system for use in the superficial femoral artery, a long curvy artery in the thigh that supplies blood to the leg.

“The value of this study, and others like it, to the physicians at Christiana Care is that it allows us to stay at the forefront of technology and participate in developing and assessing new devices and techniques for treating cardiovascular disease,” says Daniel A. Leung, M.D., Christiana Care vascular and interventional radiologist. “Our patients also benefit because they have access to new technology that is not generally available.”

Stents of this type may improve outcomes for patients with PAD, which causes narrowing or occlusion of the artery, restricting blood flow to the extremities. Symptoms include cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs. Typically, the pain goes away with rest, but flares up again when walking resumes.

“This stent is made to be more flexible,” says Krista Brazell, RN, BSN, OSPREY study coordinator. “Some of the stents traditionally used are too rigid to really get through the curves of the superficial femoral artery. This new design makes the stent more flexible and able to be turned and shaped to fit inside the vessel.”

Most cases of PAD are manageable with lifestyle changes and medical therapy; however, left untreated this condition can lead to gangrene and amputation of the affected limb. The disease affects approximately 8 million Americans.

James Philhower is one of the patients enrolled in the trial. He calls the results “amazing.” Philhower’s circulation in his right leg was so bad he suffered with painful “pins and needles” for months.

“It was so bad I could barely walk,” Philhower says. “We decided to go with the new stent, and it improved 100 percent. It’s just like a new world, really.”

The pilot program is part of a larger Harmonization by Doing (HBD) initiative, a cooperative effort led by the U.S. Food & Drug Administration, the Japanese government’s regulatory body, and Terumo Medical Corp., a U.S.-based subsidiary of Terumo Corp. of Tokyo. Terumo manufactures the MISAGO stent system.

The OSPREY study will take place simultaneously at centers in the U.S. and Japan, a research approach designed to speed the time it takes to gain government approvals and bring the device to market.

“It’s exciting that we’re able to pilot this program here and get the device to market more rapidly,” says Angela DiSabatino, RN, MS, manager of Cardiovascular Clinical Trials. “Ultimately it’s a good thing for our patients.”

“This stent is made to be more flexible,” says Krista Brazell, RN, BSN, OSPREY study coordinator. “Some of the stents traditionally used are too rigid to really get through the curves of the superficial femoral artery. This new design makes the stent more flexible and able to be turned and shaped to fit inside the vessel.”

Timothy Sweeney, RN, and Latisha Gilliam, RN, review how their patients are doing at a shift change on the Transitional Surgical Unit, in front of one of the units new whiteboards that provide essential patient information such as scheduled tests, diet, activity level and therapy appointments.

All across Christiana Care Health System, physicians, nurses, staff, volunteers and even patients and families are sharpening their focus to find more value in health care resources. The 12-bed Transitional Surgical Unit (TSU) is an excellent example of how some efforts succeed in making the most of health care resources. Thanks to a dynamic, innovative initiative, the TSU was able to help reduce patient upgrades to the Intensive Care Unit by 50 percent.

The TSU’s diverse patient population has conditions ranging from traumatic brain injury to gunshot wounds, and includes other high-acuity patients in need of specialized treatment, but not necessarily an intensive care unit.

“Our goal was to learn how we could care for these higher-acuity patients in ways that both benefit the patient and reduce the expenses associated with upgrades to the ICU,” says Nurse Manager Danielle Weber, BSN.

Education was an important part of the plan. All nurses are Advanced Cardiac Life Support certified and can give Level C medications.

Some improvements, such as bedside reporting at shift changes, involved changes in routine that did not require additional technology or funding. Bedside reporting better enables nurses to detect when patients are not improving or are mentally confused.

“By taking a more visible approach, it is more readily apparent if there is a change in the patient’s condition during the shift,” Weber says.

Each day, a friend or relative designated as the family spokesperson is invited to visit at 9 a.m., when nurses—frequently accompanied by doctors—make bedside rounds. That gives families an opportunity to ask questions or voice concerns.

“In the TSU, we strive to promote patient and family centered care,” says Joan Pirrung, APRN, Trauma Program manager, who was the TSU nurse manager until last November. The unit’s medical director, Gerard Fulda, M.D., says initially doctors worried that the new rounding procedure would be a drain on time. Not so.

“What we have found is that [bedside reporting] is actually more efficient, because often doctors can talk to patients and families at the same time instead of separately,” Dr. Fulda says. “There also are occasions in which a relative volunteers an important observation or piece of information about the patient that helps the doctor to determine the best plan of care.”

The project also presented an opportunity to more clearly define the mission of the TSU. Under the initiative, heightened standards were rolled out, including:

Taking vital signs every two hours and reading EKG strips every eight hours or sooner if there is a change.

Focused assessment every two hours, including wounds, IV drug drips or drainage systems.

Full, head-to-toe assessment of patients every four hours.

Enhanced whiteboards (dry-erase boards used to convey information among staff, patients and families) brought the unit a Focus on Excellence Award and high marks from patients and relatives, with an 88 percent improvement in satisfaction in communication from post implementation surveys specific to the whiteboards. The boards include such essential patient information as scheduled tests, diet, activity level, and appointments for physical therapy, occupational therapy and speech therapy. A message center enables patients and relatives to write notes to doctors and nurses.

“Our pre- and post-survey results showed improved staff, physician, patient and family satisfaction in regards to the communication board,” Pirrung says. “The transformation of the unit has been incredible and will only get better with the patient always placed at the center.”

In a six-month span in 2010, the 50 percent decline in ICU upgrades resulted in savings of $45,500, based on one day of care and the difference between the TSU daily charge of $1,400 and ICU charge of $2,700. In addition, patient falls fell 66 percent.

“Christiana Care has empowered nurses to have a say in how their units are run,” Weber says. “As a nurse of 16 years, I can say that is a wonderful feeling. We are making a difference for patients, their families and the health care system,” Weber says. “It’s not easy to change your whole way of thinking, but we did it as a team.”

Chair of the Department of Surgery Michael Rhodes, M.D., was among the speakers at the Christiana Care Value Institute symposium "Defining Value in the Surgical Environment."

Christiana Care’s Value Institute held a symposium titled “Defining Value in the Surgical Environment.” Speakers included Robert Laskowski, M.D., CEO and president of Christiana Care Health System, Richard J. Derman, M.D., chair of Obstetrics and Gynecology, and Michael Rhodes, M.D., chair of Surgery. Nearly 300 health care workers attended the symposium, which is a lead-up to the larger Christiana Care Value Institute Symposium scheduled for April 30, 2012.

Barbara Levy, M.D., the former president of the American Association of Gynecologic Laparoscopists and a frequent guest on the Oprah Winfrey show, was the keynote speaker. Levy, a practicing gynecologist in Seattle, Wash., said that with the right steps in place, gynecologists can successfully perform hysterectomies on an outpatient basis.

Hysterectomies historically have kept women in the hospital for about two or three days. During her presentation, Levy cited research that showed that the average outpatient hysterectomy costs substantially less than the inpatient procedure. The research also showed that the vast majority of outpatient hysterectomies did not require subsequent hospitalization.

“We have incredible prejudice on what we think works best,” Levy said. “But what we need to do is look for meaningful outcomes. … With outpatient hysterectomies, you can save 20 percent to 25 percent in costs.” For example, if surgeons administer DVT prophylaxis and carefully handle the patient’s tissue, among other actions, they can increase the likelihood that the outpatient hysterectomy will be successful, Levy said.

During the conference, doctors also heard from Mark J. Garcia, M.D., FSIR. Garcia is the chief of interventional radiology at Christiana Care and one of few interventionalists nationwide who specializes in the treatment of chronic clots. Garcia showed how embolization is used for the treatment of uterine fibroids. His presentation included information that showed how fibroid embolization is both clinically effective and cost-efficient when compared to other surgical methods.

Kidney Transplant Program team members: Helen Chang-DeGuzman, M.D.; Stephanie Gilibert, M.D.; Terina Williams, BSN, RN; Eileen Edge, MSW, LCSW; Megan Dill; Geri LiBetti, RN, BSN, CCTC; Catalina Read, RN, BSN, CCTC; Nadia Hellenga, Pharm.D; Emily Pruitt, RN, MSN; Loretta Perry; Grace Franceschini; Laura Bishop, MS, RD, LDN; Gail Eastman, MSN, APN-C; Barbara Demyanovich; and Velma Scantlebury, M.D.

Jan. 15 marked the fifth anniversary of adult kidney transplants being performed in Delaware. To date, Christiana Care has performed 104 transplants, with the number of procedures increasing every year of the program.

A transplant program close to home is now a fact of life throughout Delaware. A second transplant clinic in Lewes allows patients from the central and southern counties in Delaware to be seen more easily by members of the team.

During the program’s early years, patients received postoperative care in the Transitional Surgery Unit. Over the past year, the team has educated and formed close working relationships with the nursing staff on unit 4C, which allows our kidney-transplant patients to return directly to a private room on a regular nursing unit. The 4C staff, under the direction of Sharon Urban, MSN, has delivered excellent care to patients.

S. John Swanson III, M.D.

“Being close and homegrown is very important,” says S. John Swanson III, M.D., FACS, chief of the Christiana Care Kidney Transplant Program. “The familiarity of people from Delaware taking care of people who also are from Delaware is very comforting.”

The same multidisciplinary team members follow transplant recipients after discharge from their transplant hospital stay. After discharge, patients may opt for follow-up care through a collaborative project with Christiana Care Visiting Nurse Association, which extends the support systems for transplant patients by providing home care visits immediately after discharge and continuing as needed until they are confident in caring for their new kidneys.

Dr. Swanson became Christiana Care’s first chief of Transplant Surgery in July 2006, after serving as chief of Kidney Transplant Surgery at Walter Reed Army Hospital. He retired from the U.S. Army, Medical Corps, as a colonel in 2005. Dr. Swanson performed the 100th kidney transplant procedure at Christiana Care in September 2011.

Tony Porter, co-founder of A Call to Men, speaks about domestic violence at the 9th Annual Domestic Violence Prevention Forum in Wilmington, Del.

Christiana Care, a National Community Center of Excellence in Women’s Health, has been working for years to help women who are victims of domestic violence at an annual event that offers resources, education and support.

“In 2011, we decided to take a different approach by talking directly to men,” said Liz O’Neill, project director, Department of Family and Community Medicine. “To do that, we worked with men and men’s groups throughout the community, from the Wilmington Police Department to the Delaware Division of Public Health to the clergy.”

More than 150 men, teens and the women who love them recently attended the 9th Annual Domestic Violence Prevention Forum at Ezion Fair Baptist Church in the city’s Southbridge neighborhood.

The keynote speaker was Tony Porter, co-founder of A Call to Men, a nationally recognized organization based in New York that is committed to ending violence against women.

In his address, Porter said the problem of abuse toward women is two-pronged—including both men who physically harm women and men who do not intervene.

He called out for men to take a strong stance in standing up for positive male role models who support respect for women and also advocate for women.

The American Medical Association estimates that almost 4 million men severely assault an intimate female partner each year. Assault is the leading cause of injury for women, accounting for at least 35 percent of visits to the Emergency Department.

“Domestic violence is an important women’s health issue,” says Richard J. Derman, M.D., MPH, chair, Obstetrics and Gynecology at Christiana Care. “Preventing abuse through community partnerships that promote education and awareness can save women’s lives.”

Christiana Care is committed to caring for its neighbors by bringing essential information and education to people who need it, going straight to the community. In addition to Porter’s speech, the event included roundtable discussions of domestic violence, as well as a video presentation.

The forum was months in the making, with Christiana Care coordinating input from men’s organizations, as well as the Delaware Coalition Against Domestic Violence, Delaware Girls’ Initiative, Latin American Community Center, Henrietta Johnson Medical Center, Westside Health Inc. and other groups.

“It was a broad-based and very active planning committee, with many people working together to reach out to men on this important issue,” O’Neill says.

In addition to Christiana Care, funding for the event was provided by the Delaware Division of Behavioral Health.

Photo gallery: 9th Annual Domestic Violence Prevention Forum

Mitchell T. Saltzberg, M.D., FAHA, FACC

Christiana Care is teaming up with Thomas Jefferson and Temple universities in Philadelphia to form one of only nine elite National Institutes of Health Heart Failure Clinical Research Centers in the nation.

The Christiana Care Heart Failure Program will provide scientific leadership for the seven-year project, which focuses on small to intermediate randomized clinical trials devoted to improving outcomes for heart failure patients.

“It is a very exclusive group, and we are grateful and honored to be named to one of nine regional centers in the U.S.,” says Mitchell Saltzberg, M.D., medical director of the Heart Failure Program at the Center for Heart & Vascular Health and the principle investigator for Christiana Care.

The network promotes collaboration that will help to find treatments for patients with heart failure, a serious condition that impairs the heart’s ability to pump blood, causing severe fatigue, shortness of breath and swelling. Heart failure kills more than 275,000 people a year in the U.S. and is the leading cause of hospitalization in patients over age 65.

The national network, like similarly designed collaborations for the study of asthma, autism and rare diseases, pools data from patients at multiple sites to strengthen and speed up research that would otherwise take much longer.

Christiana Care will receive $269,000 in funding from the National Heart, Lung and Blood Institute at NIH, in addition to proceeds from all network research trials that the health system participates in through 2018.

Dr. Saltzberg says the award extends far beyond financial help. The nine centers bring together the brightest and best minds in heart failure care from all over the country to create a forum to test novel theories to advance heart failure treatment options.

“The network allows for a rapid deployment,” he says. “It makes it much easier to engage a wide number of doctors with a wide range of experience in research.”

Clinical trials will be in short- to mid-term cycles, lasting from two to five years. As a first step, Christiana Care is reviewing practices for three procedures to enroll patients in trials related to them. The health system also expects to participate in nine other clinical trials as a result of the NIH award.

“This is an exciting opportunity to make advances that will help heart failure patients,” Dr. Saltzberg says. “It is a true joint effort and we look forward to being active players on a prestigious team.”

Heather Bittner Fagan, M.D., FAAFP, MPH

The relationship between obesity and cancer screening is more complicated than previously thought, according to a recent study led by the Department of Family and Community Medicine at Christiana Care Health System.

In an article published in the Journal of Obesity by lead author Heather Bittner Fagan, M.D., FAAFP, MPH, director of Health Services Research, Department of Family and Community Medicine, Christiana Care Health System, the study found this relationship depends on the type of cancer screening test used.

The study found obesity is associated with higher rates of prostate cancer screening among all races as well as lower rates of cervical cancer screening predominantly in white women.

The data on breast and colon cancer screening were contradictory, suggesting the possibility of other determinants such as race, gender, ethnicity and access to care. Original analysis was also conducted examining the role of race, gender and ethnicity in moderating the relationship between obesity and colorectal cancer screening (CRC) and showed that weight status does not contribute to disparities in CRC screening in race/ethnicity and gender subgroups.

“Numerous studies have suggested that obesity constitutes an obstacle to cancer screening, but a deeper examination also considering the role of race/ethnicity and gender in the equation has not been done before,” said Dr. Bittner Fagan, who is also associate professor at Thomas Jefferson University in Philadelphia. “A greater understanding of the relationship between cancer screening and obesity, race/ethnicity and gender can also help explain the association between obesity and increased cancer mortality.”

Emergency care technician Isaac Bennett, Isabel Pearce, RN, and Rebecca Lambert, RN, use the CHAT bedside shift reporting process to ensure a patient's care is handed off safely between nursing shifts.

A bedside reporting system piloted in the Wilmington Hospital Emergency Department aims to improve patient hand-offs throughout the hospital. Nurses in the Wilmington Hospital ED have been using the system, called CHAT, for almost one year now, rolling it out slowly so everyone has had a chance to get used to the change in shift reports.

CHAT stands for: C—Communicate and Clear; H—History; A—Assessment and Actions; T—Treatment Plan.

The two nurses who spearheaded the initiative in the Wilmington Emergency Department are Isabel Pearce, RN, and Nicole McCarry, RN. In addition to conducting the training and working to alleviate their colleagues’ concerns about the process, Pearce and McCarry also conducted a six-month study to look at how bedside reporting would impact both patient and nurse satisfaction.

“The results in terms of patient satisfaction were almost immediate. Scores have reached the highest level in the department’s history, mirroring experiences of other ED bedside report models across the country,” Pearce says. “The data supports the theory that bedside reporting increases patient satisfaction and positive patient outcomes. Even length of stay can be decreased, because the oncoming nurse is told of impending lab and imaging results, which when available allow the nurse to partner with the physician for a timely disposition.”

For McCarry, it has always been part of her nursing style to include patients in their own care. Formalizing a system of reporting between shifts just made sense to her.

“The most obvious benefit is patient satisfaction,” McCarry says. “Patients are very happy with feeling that they are not being abandoned when one nurse ends a shift and another comes on. The patients are more aware, and they develop a genuine respect for the nurses and staff.

“From the nurse’s perspective, it doesn’t leave you questioning what may or may not have been done. If there is an acute change, you recognize it quickly. For example, you have been told a patient was talkative, and now the patient is slow to even respond. If both nurses are standing there, you can ask, ‘Is this how they were earlier?’ It’s a good, visual, hands-on approach to hand-offs. And it’s better for care.”

At Wilmington Hospital, nurses in the Emergency Department are using CHAT approximately 85–90 percent of the time, says Susan Angeline, RN, nurse manager of the Wilmington Emergency Department. The goal is to reach 100 percent compliance in the next year.

The nurses who coordinated the CHAT roll-out admit that it can be difficult to accommodate such a big change in the way reporting has always been done—generally at the nursing desk where patients can’t hear any of the nursing report. Some nurses were concerned about conducting bedside report in special patient populations where patients might be intoxicated, combative or have an acute mental status change.

“Although bedside reporting can be uncomfortable, in most cases it’s actually safer for nurses and patients for the oncoming nurse to get that accurate assessment at the beginning of his or her shift,” Pearce says. “Many of those ‘uncomfortable’ patients are at the highest risk for falls and change in condition. Bedside reporting and the additional care it brings can help protect the patient, but also helps protect the nurses and their licenses by accurate assessment at the nurse’s assumption of care.”

She adds that CHAT doesn’t require nurses to share all information at the patient’s bedside. If there are issues that need to be shared only between the two nurses, it’s appropriate to share that information outside of the patient’s room.

“Resistance to the change fades quickly once nurses begin to see the benefits of CHAT,” McCarry says. “It really is better for the patients and for the nurses. Everyone will eventually see this is the direction we are going in, and it is a positive thing.”

Matthew K. Hoffman, M.D.

Christiana Care is taking a leading role in developing national guidelines for the obstetrical practice of episiotomy, which is a surgical incision to enlarge the vaginal opening during childbirth in order to aid delivery and prevent tissue damage.

“Establishing national standards will benefit patients across the country,” says Matthew Hoffman, M.D., MPH, director of OB/GYN Education & Research at Christiana Care, one of the nation’s highest-volume health systems for delivering babies. “At the very least, episiotomy causes pain for mothers—and most of the time that pain is unnecessary.”

Under current guidelines in obstetrics, episiotomy is a routine practice. On Nov. 30, the National Quality Forum endorsed Christiana Care’s petition to consider the incidence of episiotomy as a performance measure in evaluating the quality of perinatal services. The National Quality Forum is a nonprofit organization that endorses national consensus standards for measuring and publicly reporting on health care performance. National Quality Forum endorsement takes the standard of low episiotomy rates a step closer to becoming adopted by the Joint Commission, the independent, not-for-profit organization that accredits and certifies health care systems.

Episiotomy was routine for decades and was a standard part of training for most obstetricians practicing today, Dr. Hoffman says. In theory, the procedure prevented more serious vaginal tears, as well as reduced the patient’s risk of incontinence. But over time, the evidence didn’t support that theory. In fact, data shows that episiotomy increases the risk of serious lacerations. The procedure also can contribute to incontinence of stool.

The petition to the National Quality Forum by Christiana Care and the National Perinatal Information Center (NPIC) is part of the health care system’s ongoing commitment to providing quality care. To support the goal of establishing episiotomy rate as an indicator of quality, Christiana Care launched an educational program for providers of OB/GYN services on the procedure and the lack of benefit to patients, starting in October 2008.

“We also began tracking and presenting how we are doing with our episiotomy rate every month at our OB/GYN business meeting,” says Linda Daniel, director, Performance Improvement/Care Management, Women and Children. Between the fiscal years 2008–2010, the rate of episiotomy declined 55 percent at Christiana Care. In 2010, only 1 percent of obstetricians in the health care system had an episiotomy rate of more than 20 percent, compared to 25 percent of physicians in 2004.

Overall, the episiotomy rate at Christiana Care is currently about 2 percent. There is an exclusion for shoulder dystocia, a rare and dangerous condition that occurs when a baby’s anterior shoulder cannot pass beneath the joint that connects the mother’s pubic bones after the baby’s head has been delivered.

“In theory, the doctor might need additional room to perform the manipulations required to deliver the baby safely,” Daniel says.

The measure was tested with the help of NPIC, as well as Christiana Care’s fellow members of the Counsel of Women and Infant Specialty Hospitals (CWISH) to validate the measure’s reliability, feasibility and usability. Episiotomy rates from NPIC’s database were far higher than those at Christiana Care, averaging 12.9 percent. CWISH rates averaged 16.2 percent.

“In the future, hospitals will be judged on their episiotomy rates as a quality marker,” Dr. Hoffman says. “Christiana Care is already there.”

Hand washing, one of the most crucial practices for fighting hospital infections, reached 100 percent compliance on six nursing units over six months in 2011.

Christiana Care staff “silent observers” found no exceptions from January through June on 5E, 5D, 4D, 7E and TSU at Christiana Hospital, and on Wilmington Hospital’s Unit 3 West.

Hand hygiene consistency was a key factor behind an 11 percent reduction in the number of patients placed at harm this year, said Bob Laskowski, M.D., MBA, president and CEO of Christiana Care, during a biannual presentation to the Christiana Care Board of Trustees in November. That’s a full percentage point ahead of the year-end goal of 10 percent.

Clean hands prevent the spread of common illnesses—such as the cold—as well as more serious diseases such as hepatitis A, meningitis, the flu and infectious diarrhea.

“When you have a large number of isolation patients as we do, it becomes more and more of a challenge to protect them from infections,” says Beth Rathmanner, RN, 5E nurse manager. “Very rarely do we ever drop,” she says, despite being a relatively large (30-bed) unit running at capacity almost every day. The unit cares for heart failure and cardiac patients—a large percentage of whom have co-morbidities—with a typical age range of 75 to 79.

One-hundred-percent-compliant hand hygiene practices observed on 4D—a 35-bed surgical stepdown unit—have been recognized both internally and nationally. The unit’s increased hand washing rates were linked to a drop in C. difficile rates by 50 percent. The staff’s dedication earned the Nursing – Structural Empowerment Award at the Focus on Excellence Awards program in December. The unit’s Quality and Safety Council accepted the award for its hand hygiene campaign, which included innovative handwashing games and a catchy music video, “Get Your Clean On,” which placed third in an infection-prevention video contest sponsored by 3M.

“We had staff buy-in from the very beginning,” says 4D Nurse Manager Karen McCloud, RN. “For the video, they wrote the music, sang and danced for it. When you have that kind of buy-in, you’re going to follow through with a high compliance rate. Every member at every level of our unit bought into improvement.”

On Unit 3W at Wilmington Hospital—the psychiatric unit—patients generally don’t face the same serious medical conditions as other units, says Nurse Manager Marge Bailey, RN. But the importance of handwashing has been so instilled in the culture there that they too received 100 percent compliance.

“I don’t think our thoughts are any different than if we were working on a med-surg unit,” Bailey says. “Everywhere in a hospital there’s a potential for the transmission of disease. Even if patients are healthy, we still are worried about transmission.”

The two dozen health care workers on the psychiatric unit also take measures to encourage hand washing among the patients. In the joint dining hall, for example, the mental-health associate monitoring the meals ensures that all the patients gel their hands before eating.

Letting people know when they neglect to wash their hands before entering a patient’s room is another key to reaching the gold standard, says Jennifer Johnson, nurse manager of Christiana Hospital’s Unit 7E, a spine surgical and bariatric unit with a 100 percent handwashing compliance record, where nurses and patient-care technicians don’t hesitate to remind surgeons about hand washing if they forget, and vice versa, Johnson says.

“Everyone makes mistakes, but if we see someone who forgets to wash their hands we do point it out,” she says.

Nationally known patient-safety expert Michael Leonard, M.D., spoke about fostering a culture of safety at Christiana Care's 9th Annual Focus on Excellence Awards.

Hospitals don’t have to hire rocket scientists to create a culture of safety, nationally renowned patient safety expert Michael Leonard, M.D., said during the Focus on Excellence Awards at Christiana Hospital’s John H. Ammon Medical Education Center. Rather, hospitals simply need to embolden every member of their health care teams—from the surgeon to the nurse to the custodian—with the power to speak up if they observe something either wrong or questionable regarding the treatment of a patient under their watch.

“The issue we are looking at is how to create an environment where no one is hesitant to speak up,” said Dr. Leonard, an anesthesiologist and a principal at Pascal Metrics. “At some places, the housekeeper has been the worker who told the surgeon that they were doing a wrong-site surgery.”

Dr. Leonard is one of the foremost experts on patient safety, having trained more than 1,000 patient-safety officers worldwide. He also co-published “The Essential Guide for Patient Safety Officers.”

It’s one thing for hospitals to adopt nationally-recognized policies that encourage patient safety, Dr. Leonard said, but tangible improvement only occurs when the staff members feel responsible to adhere to those policies. When all members of a health care team prioritize patient safety, the hospital is on the road to lower rates of unnecessary infections, wrong-site surgeries and medication errors.

“Culture’s local,” Dr. Leonard said. “Systems evolve broadly but culture evolves at the local level.” Patient safety links inextricably to psychological safety among the health care workers, he observed. No employee should fear that they will be punished or humiliated for speaking up with ideas, questions and concerns.

A disarming way to bring up a concern, Dr. Leonard said, is to declare, “I need some clarification.”

“You want everyone to feel comfortable raising their hands and voicing a concern,” he said.

Another key component is to measure and track patient safety throughout the year. Those charted measurements should be documented and mounted in a public place of the hospital—such as a hallway or boardroom—so that patient safety is more fully permeated into the hospital’s culture.

Dr. Leonard said that the “Focus on Excellence” initiative by Christiana Care reflects the health system’s commitment to patient safety. Christiana Care’s goal is to become one of the top patient-safety health systems in the nation and boast both the lowest cost of care and best outcome of care in the mid-Atlantic Region among health systems.

“You guys are doing a lot of wonderful things,” he said.

Dr. Leonard cited studies published in the Journal of the American Medical Association and The New England Journal of Medicine that demonstrate how effective communication and teamwork results in better patient outcomes.

He listed other steps that embody a culture of safety: Health care staff should rehearse procedures they are about to perform. When mistakes are made, the staff should reconvene to evaluate where the failure occurred, as opposed to who made the error. Those actions also decrease the likelihood of recurrence.

“The challenge that we are facing is to hardwire these basic processes into the way we treat patients every day,” he said. “It is simple thing to do but it also is a hard thing to do. Still, it is an intentional act that we must take to improve patient safety.”

President and CEO Robert J. Laskowski, M.D., MBA, opened the 9th Annual Focus on Excellence Awards program by observing that the yearly gathering is an opportunity for staff to celebrate shared beliefs, including the importance of a culture of safety and a commitment to value.

Christiana Care’s 9th Annual Focus on Excellence Awards program, Dec. 1, gave formal recognition to 24 teams of employees who entered projects demonstrating improvement in process or outcomes using the PDCA (Plan-Do-Check-Act) model.

“Thank you for being an inspiration to me and to each other,” said Christiana Care Health System President and CEO Robert J. Laskowski, M.D., MBA. “Our culture of excellence shows up in each one of us. It is evident in the way we care for each other and for our neighbors. We learn from each other.”

Special guest speaker Michael Leonard, M.D., a nationally renowed patient-safety expert, provided his insights on how health systems can form cultures of safety. Categories this year included awards for Nursing (6), Clinical Excellence (3), Community Health (2), Operations (2), Financial Strength (1), Learning Excellence (1), Great Place to Work (1), Safety (2), Employee Safety (1), Think of Yourself As a Patient (1), Residents (1), People’s Choice (1) President’s Award (1), plus a new award for Value in the Clinical Excellence category.

Amanda Nicholas flanked by Barbara Albani, M.D., and Gregg Zoarski, M.D., two of the surgeons who saved her life after she experienced a rare injury to her carotid artery.

Neurointerventionalist Gregg Zoarski, M.D.’s recent surgical grand rounds lecture on carotid artery injuries focused on how to repair traumatic injuries to these vital vessels that supply blood to the brain.

“It’s a very, very rare injury, and it’s something you may not see in an entire year,” said Christiana Care Trauma Center Medical Director Mark D. Cipolle, M.D., one of the doctors who listened to Dr. Zoarski’s lecture.

Dr. Cipolle probably should have knocked on wood.

Only one hour after Dr. Zoarski’s lecture ended, a patient with an injured carotid artery was airlifted to Christiana Hospital’s Level 1 Trauma Center from Bayhealth’s Kent General Hospital in Dover.

Amanda Nicholas, 19, of Camden-Wyoming, received a carotid artery injury from her shoulder-harness strap in a car collision.

While Amanda was fully conscious, Bayhealth surgeon Assar Rather, M.D., observed unexpected changes in his patient the morning after the accident. Nicholas’s face began drooping, and her speech started slurring, indicating that she was having a stroke. A CT angiogram confirmed that Nicholas was losing blood flow to her brain.

“I got alarmed because she is a young patient,” said Dr. Rather. “It is one of those injuries that, if not detected in a short time period, can cause long-term problems, such as disability or death. Any delay is dangerous.”

Dr. Rather believed Nicholas needed a stent implanted in her carotid artery—an operation that could be completed only at a hospital with a neurointensive care unit and neurointerventional specialists. He referred Nicholas to Christiana Hospital.

“I wanted the stents because I wanted every chance for Nicholas to get better,” Dr. Rather said.

Nicholas arrived at Christiana Hospital at about 11 a.m., only three hours after Dr. Zoarski’s lecture ended. Dr. Cipolle immediately directed Nicholas’s case to the neurointensive care unit, so Dr. Zoarski could implant a stent in her carotid artery and treat the clots that had blocked the small but vital vessels to her brain.

“This case was amazing in that I knew during the lecture that I might not see one of these sorts of cases in the entire year and I then saw one in the next hour,” Dr. Cipolle said.

During the three-hour surgery, Dr. Zoarski worked along with Barbara J. Albani, M.D., Christiana Care’s director of neurointerventional surgery, to place a stent into Nicholas’s carotid artery, which was almost completely blocked by the injury. The stent opened the carotid artery and helped restore normal blood flow to Nicholas’s brain. The doctors also removed clots from her body with a minimally invasive medical device known as a Penumbra Stroke System in combination with the clot-busting drug known as tPA.

“The stent was key to her survival and complete recovery,” Dr. Zoarski said. “It is a coincidence to give a lecture at 7 a.m. on that subject and then do the same surgery a few hours later.”

Nicholas left Christiana Hospital after a two-night stay. She returned for a follow-up visit on Wednesday, Nov. 23, and took the opportunity to thank the health care team that saved her life.

“I’m grateful that I don’t have brain damage and I’m not dead,” Nicholas said. “I’m grateful that they did the surgery and that I’m fine.”

Neurointerventional surgery

The Christiana Care Neurointerventional Surgery team provides 24/7 minimally invasive services and treatments in a state-of-the-art neurointerventional surgery suite that is unmatched in Delaware.

The team not only provides technologically advanced treatment of strokes, but can perform minimally invasive procedures to treat aneurysms and other conditions affecting the brain and spine that were once only treatable through open surgery. The advantages of neurointerventional procedures over traditional open surgery include a shorter recovery time and less pain during recovery.

Neurointerventional radiologists, including Barbara Albani, M.D., Gregg Zoarski, M.D., and Sudhakar Satti, M.D., use sophisticated technology to see inside the body in real time and manipulate tiny catheters through the patient’s blood vessels. This enables them to break up a blood clots inside the brain or to eliminate blood flow in an aneurysm to prevent it from bursting. Minimally invasive treatments are also used by neurointerventional radiologists to treat spinal conditions without exposing the spinal column.

• Promoting faculty teaching and excellence.
• Recognizing and rewarding excellence in teaching.
• Making contributions to the educational mission, promoting scholarship in medical education and fostering a community of scholars.

Congratulations to:

• Matthew Burday, D.O.
• Virginia Collier, M.D., the Hugh R. Sharp, Jr. Chair of Medicine of Christiana Care Health System.
• Moses Hochman, M.D.
• Michael Rosenthal, M.D., chair of the Department of Family & Community Medicine.

Patricia Lincoln, RN, BSN, ACRN

Patricia Lincoln, RN, BSN, ACRN received the Association of Nurses in AIDS Care’s (ANAC) HIV Educator Distinguished Service Award in November at the ANAC’s annual awards ceremony in Baltimore. The award recognizes an outstanding ANAC member who, through HIV/AIDS Education, has had a great impact on the lives of those they have instructed, including patients, clients, families, health care providers, community groups and the general public.

Lincoln is the site director of the Christiana Care-based performance site of the Pennsylvania/ Mid- Atlantic AIDS Education Training Center. She provides and coordinates comprehensive, quality educational programs regarding HIV to health care workers and individuals in and leads a team that serves as a resource center for the information regarding HIV medical management, research protocols and referral information.

One of the first RNs to work for Christiana Care HIV outpatient clinical program, Lincoln has been dedicated to the care of HIV infected and affected individuals since the beginning of the epidemic. She has been instrumental in developing and teaching the ANAC Aids Certified Registered Nurse (ACRN) exam.

“Pat is the definition of a nurse educator,” says Linda Frank, Ph.D, MSN, ACRN, FAAN, executive director of the Pennsylvania/Mid Atlantic AIDS Education and Training Centers. “She is committed, enthusiastic and dedicated to improving the lives of persons living with HIV.”

At the Latinas: Strong and Healthy event, a Community Service Award was presented to the family of Marisol Mercado, who was dedicated to encouraging Latinas to receive regular mammograms in order to detect breast cancer early, when it is most effectively treated. Mercado died in February.

For six years, Latinas Fuertes Y Saludables—Latinas: Strong and Healthy—has been a life-affirming event for Hispanic women who are empowered with education about healthy living and encouraged to share their knowledge with others.

More than 250 people recently gathered at Bayard Middle School, where Christiana Care Community Health Outreach and Education workers and partner agencies again brought life-saving information on cancer and other diseases directly to the people. This year’s partner agencies included the Delaware Breast Coalition, Westside Family Healthcare, Henrietta Johnson Medical Center, Delaware’s Division of Public Health, Latin American Community Center and the Susan G. Komen for the Cure Philadelphia Affiliate.

Eighteen promotoras—promoters of health education— came together at the event to share their message with other Latinas in Delaware’s rapidly growing Hispanic population. The promotoras are volunteers trained in breast care outreach at Christiana Care’s Helen F. Graham Cancer Center.

“Each one of the promotoras represents a connection in a family network who can reach out to others,” says Nora Katurakes, manager of the Community Health Outreach & Education Department. “They are peer educators who are active in their communities, day in and day out.”

Spanish-speaking Christiana Care outreach workers, assisted by the Hispanic Nurses Association, also arranged screenings for cancer assessment, diabetes, cholesterol and blood pressure for 65 people. In addition, 100 individuals were vaccinated against flu.

Nine women received mammograms at a mobile van that day. Christiana Care workers followed up with an additional nine women after the event and also arranged for them to get testing.

Zohra Ali-Khan Catts, director of the Cancer Genetics Program at the Helen F. Graham Center, spoke with women about the role genetics plays in some forms of cancer and the benefits of undergoing genetic testing. Dr. Marielena Velez, department of family medicine and Joceline Valentin, Community Outreach Coordinator /Women’s Health Navigator and the chair of the event, spoke with women about caring for themselves and local resources available to help fund breast cancer screenings.

The October event was part of Christiana Care’s year-round effort to reach out to neighbors who don’t have adequate access to health care, screenings and preventive care. By providing free tests and bilingual education in a community setting, Christiana Care and partners are working together to remove barriers to care and getting the word out to more people in need.

A Community Service Award was presented to the family of Marisol Mercado, who was dedicated to encouraging Latinas to receive regular mammograms in order to detect breast cancer early, when it is most effectively treated. Mercado died in February.

“Marisol participated in our first Latinas event and is a shining example of what a promotora can do by talking with others about breast health and caring for yourself so that you are able to care for your family,” Katurakes says.

Photo gallery: Latinas Fuertes Y Saludables

Students of the Class of 2013 are enjoying their experience as the first contingent to learn at Christiana Hospital since its designation as a Jefferson Medical College branch campus.

Christiana Care is participating in Jefferson Medical College’s Delaware Branch Campus program, underscoring the transformative role the health system plays in medical education.

This achievement specifically spotlights our core competency in providing clinical education to third- and fourth-year medical students. Christiana Care has a long-standing relationship in providing first-rate medical education to students from Jefferson, one of the country’s top-rated medical collleges.

As a branch campus, Christiana Care can provide better care to our neighbors by allowing these students to receive additional medical education opportunities on our campus. Plus, receiving more of their clinical training at Christiana Care increases the likelihood that these students remain to practice in Delaware when they complete their residency training.

This new partnership with one of the nation’s foremost medical research institutions, in collaboration with other Jefferson branch campus partners, strengthens Christiana Care’s ability to increase its research grant capacity.

Designation as a Jefferson Delaware branch campus also benefits the Delaware Health Sciences Alliance, of which we are one of four member institutions. A future Jefferson facility at the University of Delaware for medical students in Delaware is a key component of the Alliance.

Other branch campus partners include the DuPont Hospital for Children and the Wilmington VA Medical Center.

Eleven students started their third year of medical education at Christiana Care at the beginning of July. They comprise our inaugural class, the Class of 2013.

Our new medical student liaison in Academic Affairs, Christine Sowinski, MSM, is providing assistance to these and future students at our campus.

Here are some comments from the students after nearly six months at Christiana Hospital:

“Everyone in the hospital has been great to work with and I have already learned a lot. I am looking forward to continuing my rotations at Christiana Care!”

–Justin Davanzo

“Having the opportunity to learn within the education-friendly Christiana Hospital throughout mutiple rotations allows us … to truly feel a part of the team. We recognize nurses and physicians from other rotations and are able to better understand how the system works. It … beats the crowds of academic hospitals for a more individualized learning experience in a beautiful facility.”

–Upasana Joneja

“Being at Christiana Care has been a wonderful experience thus far. There is a great camaraderie among the staff I have had the opportunity to work with and this has allowed me to really feel like part of the team.”

–Amy Weniger

“Having the ability to do all of the third-year clerkships at the same hospital gives me a special opportunity to build strong and rewarding relationships with the excellent physicians, nurses and staff of Christiana Care.”

–Leonard Nowcid

Virginia Collier, M.D., FACP

Virginia U. Collier, M.D., FACP the Hugh R. Sharp Jr. Chair of the Department of Medicine at Christiana Care, joins a select group of doctors elected to Mastership of the American College of Physicians (ACP). She is the fourth Master ever elected by ACP from the state of Delaware.

Masters are highly accomplished individuals distinguished by the excellence and significance of their contributions to the ACP and the field of medicine. “A Master is a citizen physician, educational innovator, humanist and learner-teacher who inspires those around him or her and sets the standards for quality in medicine,” said Tanveer P. Mir, M.D., MACP, chair of the ACP awards committee. “As a Master of the American College of Physicians, you embody these qualities,” she said, referring to Dr. Collier.

As a Master, Dr. Collier can use the initials MACP after her name to mark the designation.

Dr. Collier finished a second three-year term as a Regent of ACP in April 2010. From 2000-2004, she served as governor of the Delaware Chapter of ACP. She received the ACP Delaware Chapter Laureate Award in 2009. Dr. Collier has served on many ACP committees and subcommittees.

Dr. Collier is the recipient of numerous awards for her contribution to medical education. In 2002, she was the inaugural winner of the Accreditation Council for Graduate Medical Education Parker Palmer Courage to Teach award. In 2003, she received the Leon A. Peris Memorial Award of Jefferson Medical College for excellence in clinical teaching and for being an exemplary role model in academic medicine.

Dr. Collier attended the Johns Hopkins School of Medicine, Baltimore, and performed her medical internship and residency on the Osler Medical Service at the Johns Hopkins Hospital, where she also completed a fellowship in nephrology. She joined Christiana Care in 1989 as director of the Fourth Year Student Program in the Department of Medicine. She is professor of medicine at Thomas Jefferson Medical College, Philadelphia.

ACP is a national organization of internists — physicians who specialize in the prevention, detection and treatment of illnesses in adults. It is the largest medical-specialty organization and second-largest physician group in the U.S. ACP membership of 132,000 includes internists, internal medicine subspecialists and medical students, residents and fellows.

AHRQ is the research arm of the U.S. Department of Health and Human Services focusing on health care quality, costs, outcomes and patient safety. The agency’s research complements the biomedical research mission of its sister agency, the National Institutes of Health.

Christiana Care sponsored La Comunidad Hispana's Vive tu Vida event, providing health education and free health screenings to attendees from the Hispanic community in Kennett Square, Pa.

Vive tu Vida means “Get up, get moving” and hundreds of people in the Kennett Square Hispanic community recently did just that, mobilizing to learn about nutrition, heart health, fitness and cancer screenings in an event that blended education with family fun.

Doctors from Christiana Care Cardiology of Southern Chester County demonstrated an echocardiogram, showing pictures of the way the heart works.

Marielena Velez, M.D., a Christiana Care family medicine resident who is bilingual, used labels on cereal boxes to teach how to evaluate the nutritional content of various brands and avoid foods that are high in fat, sugar and carbohydrates.

Reaching out to neighbors is an important part of Christiana Care’s commitment to serve people who currently don’t have adequate access to health care and preventive medicine.

“If you offer something the whole family can enjoy, you have the opportunity to educate many people,” says Nora Katurakes, manager, Community Health Outreach and Education. “At this event, we saw a family with three generations diagnosed with colon cancer.”

Joceline Valentin, an outreach and education coordinator who is bilingual, talked with women about breast cancer screenings and handed out brochures printed in Spanish. Hispanic women are 20 percent more likely to die from breast cancer than non-Hispanic white women diagnosed at the same age, often because the cancer is diagnosed at a later stage, according to the American Cancer Society.

The “Spin the Wheel” health game gave players the opportunity to learn more about staying healthy, as well as a chance to win such prizes as a gift card to a grocery store.

More than 225 people joined a walk around the lake at Anson B. Nixon Park, led by Timothy Gardner, M.D., medical director of Christiana Care’s Center for Heart & Vascular Health, and Rosa Colon-Kolacko, chief diversity officer and senior vice president, System Learning.

“It was great having so many colleagues from Christiana Care as volunteers at this event on a Saturday morning,” Dr. Gardner said. “This particular community is especially in need of health education and encouragement, and the Christiana Care team, led by our bilingual associates, made a major contribution. My thanks to all from Christiana Care who attended and especially to Rose Mili who organized the turnout by the Christiana Care team.”

Vive tu Vida was organized by La Comunidad Hispana, a health and social service agency serving the local Hispanic community. Christiana Care was Platinum Sponsor.

People also benefitted from 600 bags of healthy snacks and 400 pounds of apples distributed by the Chester County Food Bank. Fifty referrals were made for legal aid. Kids enjoyed tennis, lacrosse, pony rides and jumping on a moon bounce.

Guy Scotolati, director of exercise services at Christiana Care’s Eugene du Pont Preventive Medicine & Rehabilitation Institute, provided body mass index (BMI) screenings, along with essential information on weight management, nutrition and diabetes. Members of Christiana Care’s stroke team educated people in the community on the importance on keeping blood pressure under control to help lessen the odds of stroke.

To keep the lines of communication flowing, Christiana Care’s Diversity and Inclusion team worked to provide a Spanish interpreter at each table.

“When people speak the same language, that is one less barrier to health care,” Katurakes says.

Photo gallery: Vive tu Vida in Kennett Square, Pa.

Connie McKelvey, MSN, RN

The Christiana Care Visiting Nurse Association now provides psychiatric care in New Castle County, focusing first on homebound geriatric patients who are experiencing clinical depression or anxiety.

According to Connie McKelvey, MSN, RN, clinical nurse specialist for the Behavioral Health Program, depression and anxiety are the most prevalent disorders affecting the elderly and those with chronic illness.

“Studies indicate almost 25 percent of patients in general medical practices exhibit depressive symptoms,” McKelvey says. “Almost 50 percent of patients with chronic illness are experiencing depression. The elderly are more vulnerable to depression because of things such as social isolation, loss of loved ones, acute and chronic illness, and limited access to medical care. In addition, the elderly population has the highest risk for successful suicide.”

Depression can worsen chronic diseases like diabetes, heart failure, rheumatoid arthritis, hypertension, COPD, dementia, and Parkinson’s disease, at a cost of tens of billions of dollars annually. And worsening disease symptoms can lead to worsening depression.

McKelvey says the new program aims to improve medication adherence, increase quality of life, return the patient to the community, decrease hospitalizations and lower levels of depression and anxiety.

“We will remove the barriers for homebound patients to receive psychiatric care and provide a bridge to available services,” she says.

The program’s first patients will probably enter through Christiana Care’s geriatric practices and the Acute Care for the Elderly hospital-based program. Psychiatric nurses and consulting psychiatrists will provide a best-practice, evidence-based set of interventions, including evaluation and assessment, cognitive behavioral/ interpersonal therapy, family and patient education, medication management, crisis intervention, relapse prevention techniques and recommendations for further treatment.

The VNA expects to first focus on the elderly community and later expand in to include treatment to other age groups and illnesses such as dementia, bipolar disorder and schizophrenia.

Tinnitus is a conscious experience of a sound that originates in the mind—a perceived sound that is internal and cannot be heard by others.

Hyperacusis is a hearing disorder in which a person reflects abnormally strong reactions resulting from exposure to a sound. A person may experience physical discomfort as a result of exposure to quiet, medium, or loud sounds.

The prevalence of tinnitus in the United States is increasing, especially among returning military personnel. Among the general population, 17 percent (44 million Americans) experience symptoms of tinnitus. Most are able to ignore the symptoms, but some 8 million have a significant problem, and 2 million have a debilitating problem that can impact their sleep cycle and lead to depression, more noticeable symptoms and a need for professional help.

Noise exposure is the most common cause of tinnitus, but the condition is frequently associated with Meniere’s disease, hearing loss, otosclerosis, sinus/ear infections, head injury, tumors, diabetes, thyroid disorders, jaw muscle malfunctions, and more than 200 prescription and non-prescription drugs.

Tinnitus retraining therapy uses a combination of directive counseling and low-level auditory sound therapy to initiate and facilitate habituation to the tinnitus perception. The low-level sound creates sound enrichment and allows the brain to de-emphasize the tinnitus. Sound generators look like a hearing aid and emit a pleasant sound similar to that of a shower. Combination hearing-aid and sound-generator devices may be recommended when hearing loss is present. Combination instruments provide noise for the tinnitus and amplification for communication needs.

If you suspect that you might have tinnitus, avoid silence and enrich your daily life with enjoyable sounds that keep you from focusing on the tinnitus. If tinnitus, hypersensitivity or both conditions are impacting your life, you should be evaluated by an audiologist with specialty training in tinnitus and hypersensitivity.

Eric. T. Johnson, M.D.

Eric T. Johnson, M.D., began a two-year term as Christiana Care Medical-Dental Staff President on Nov. 4.

Dr. Johnson echoed praise for the history of collaboration and excellence in patient care between Christiana Care Health System and its Medical-Dental Staff as stated in welcoming remarks by Christiana Care President and CEO Robert J. Laskowski, M.D., MBA and immediate past M-D Staff President Anand P. Panwalker, M.D. Dr. Johnson said that as president he is committed to continuing the collaboration for the benefit of both organizations and the communities they mutually serve.

Dr. Johnson has been Christiana Care’s Orthopaedic Trauma Service director since 2002 and associate chief of the section of Orthopaedic Surgery, and the unit-based medical director, orthopaedic unit, since 2005. He is a 1990 graduate of the College of Medicine, The Pennsylvania State University. He completed residency in orthopaedic surgery at the Milton S. Hershey Medical Center and a fellowship in orthopaedic trauma surgery at Cooper Hospital, Robert Wood Johnson Medical School. He is a 1990 diplomate of the National Board of Medical Examiners, and a 1999 and 2008 diplomate of the American Board of Orthopaedic Surgery. He is also on clinical faculty at Wilmington Hospital and St. Francis Hospital, and he is an adjunct professor within the University of Delaware’s Physical Therapy program.

Dr. Johnson was named one of Delaware Today Magazine’s Top Docs for orthopaedic surgery in 2005, 2006 and 2007.

• “Wilmington Hospital transformation gets $1.3 million boost”  (WHYY Newsworks)
• “Wilmington Hospital will get Smart Boards” (Delaware Online)
• “ING Direct donates $1.3M to Delaware health system” (Philadelphia Business Journal)

Michael Gervay and Rae Burton will provide insight from the patients' and families' perspective to Wilmington Hospital intensive care unit staff. They are among the first members of the Wilmington Patient and Family Advisory Council to be paired with a specific hospital unit.

On Nov. 21, nurses and staff of the Wilmington Hospital intensive care unit (WICU) gathered to meet Rae Burton and Michael Gervay, among the first of approximately a dozen advisers from the Wilmington Patient and Family Advisory Council to be paired with specific hospital units.

“We’re excited to welcome you to our team,” said Dannette Mitchell, RN, who has coordinated many of the patient and family centered care initiatives at the Wilmington campus. “This is an opportunity for us to build on all of the work we’ve been doing around patient and family centered care. It’s about ‘how can we do things better?’”

Burton and Gervay both have experienced Wilmington Hospital ICU as they cared for loved ones in the hospital–Burton, her husband; and Gervay, his father. Along with the other patient and family advisers, they are volunteers who are engaged in a process of learning about how the hospital functions and providing their perspective as patient advocates.

“It is a very exciting time in health care delivery,” says Donna Casey, RN, nurse manager of the Wilmington ICU. “We are at a crossroads. Doctors and nurses are focusing less on what works best for us and more on developing systems that deliver care in ways that are best for our patients. This includes holding interdisciplinary rounds and nursing shift report at the bedside, and including the patient and family. Our advisers are an important step to helping us understand how we impact those that we care for.

“The most eye-opening revelation for me thus far was an adviser whose father had been moved from a semi-private room to a private room. The adviser told her mother that she was very afraid because the reason they were moved – she thought – was because patients are moved to private rooms who are expected to die. Of course, this wasn’t the case.

“There are so many things that we do in health care that we assume are self-evident. Our advisers are helping us to re-engineer how we deliver the best care to our patients.”

Photo gallery: WICU staff welcomes patient and family advisers

Christiana Care's Community Clinical Oncology Program at the Helen F. Graham Cancer Center ranks among the top enrollers in cancer trials. Patients who join a clinical trial benefit from techniques and therapeutic advances that are at the vanguard of medical science.

Christiana Care’s Community Clinical Oncology Program is one of the nation’s top enrollers in cancer clinical trials in the newly formed Alliance of Clinical Trials in Oncology.

According to the Alliance’s Accrual Data and Protocol listing (Sept. 1, 2010–Aug. 31, 2011), the Christiana Care CCOP ranks number 6 in treatment trials and 1 in cancer control trials that seek to prevent cancer or control its incidence.

When the listings are combined, the Christiana Care CCOP ranks number 3 out of 210 participating organizations, ahead of many nationally recognized cancer programs such as Mayo Clinic, Cleveland Clinic, The Ohio State University Medical Center and MD Anderson Cancer Center.

Members of the Christiana Care CCOP included in the Alliance rankings are Christiana Care, Union Hospital, Cooper University Hospital and Beebe Medical Center.

“This is an exceptional achievement owing to dedication and hard work of all participants in the Christiana Care CCOP,” says Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center.

At 24 percent, Christiana Care’s Helen F. Graham Cancer Center has one of the highest patient accrual rates into cancer clinical trials in the U.S., far above the national average of 4 percent.

The Alliance, formed earlier this year, merges three National Cancer Institute (NCI) funded research cooperative groups: Cancer and Leukemia Group B (CALGB), North Central Cancer Treatment Group (NCCTG) and the American College of Surgeons Oncology Group (ACOSOG). The integration into one cooperative group leverages the talents and resources of all three to bring the latest cancer control, prevention and treatment clinical trials more quickly to patients at their community cancer centers. NCI cooperative groups enroll some 25,000 patients in clinical trials each year.

Christiana Care Medical Oncologist Stephen S. Grubbs, M.D., served as a member of an Institute of Medicine planning group that recommended combining the three groups. Dr. Grubbs has since been elected to the Alliance Board of Directors and the Executive Committee, responsible for recommending overall policy and direction. Kandie Dempsey, MS, RN, OCN, CCRP, Cancer Research director, was appointed chair of the Alliance’s Clinical Research Professionals Committee, representing the certified professionals who monitor and ensure compliance with clinical trial protocols at their respective institutions in the United States and Canada.

Also receiving committee appointments to the Alliance are Andrew Himelstein, M.D., Jon Strasser, M.D., Diana Dickson-Witmer, M.D., Gregory Masters, M.D., Thomas Bauer, M.D. and Michael Guarino, M.D.

Christiana Care Health System received a $1.3 million gift from ING DIRECT that will support SMART Board technology throughout the Wilmington Hospital Campus and keep patients and their families more fully informed during their hospital stay. Thanks to the gift from ING DIRECT, the nation’s largest direct bank headquartered in Wilmington, DE, Christiana Care is now significantly closer to completing the transformation project – the most expansive in the hospital system’s history.

The new campus scheduled for completion in 2014 features:

• An Emergency Department double in size
• 120 new patient beds and a new Intensive Care Unit
• A nine-story surgical tower
• A new 61,000-square-foot medical office building
• A newly-designed front entrance and Jefferson Street approach to improve ease of access to the facility

ING DIRECT’s gift is one of the largest made in support of the landmark Wilmington Campus expansion. The gift reflects the commitment of ING DIRECT to supporting Wilmington projects that improve the lives of the families within our community. Similar to the Wilmington Campus transformation, a growing number of hospitals across the nation are harnessing technology to improve the patient’s experience while in the hospital.

Christiana Care breaks ground in Middletown
Newark Post
On November 30, representatives from the Town of Middletown, Christiana Care Health System, state government, and a host of invitees …

Work begins on Middletown ER facility
The News Journal
Christiana Care executives say they will open an around-the-clock, … 299 and Brick Mill Road at a ceremony that included Christiana Care President Robert …

Delaware hospital breaks ground on new campus
Newsworks.org
Christiana Care Health System is expanding to southern New Castle County, breaking ground on a new facility in Middletown Wednesday afternoon …

Christiana emergency care center groundbreaking
WDEL 1150AM VIDEO
Emergency medical care will soon be available to residents in southern New Castle County.

James Landsness enjoys his new-found strength while walking with Noelle Rogers, physical therapist, at the Center for Heart & Vascular Health at Christiana Care. Landsness is the first person to receive a left ventricular assist device at Christiana Care, which has enabled him to overcome the symptoms of heart failure and be active again.

In early September, James Landsness’ end-stage heart failure made him unable to complete the 60-foot walk to his mailbox.

Today, Landsness does 27 daily laps to his mailbox for exercise, feeling stronger every day.

On Sept. 13, he became the first patient to receive a left ventricular assist device (LVAD) at Christiana Care, thanks in large part to the generosity of the Crystal Trust, which provided major funding for this advanced technology at the Center for Heart & Vascular Health.

“It’s like someone walking up to you and saying, ‘Here’s your life back.’ It really was amazing for me. I didn’t think something like that was possible,” Landsness says.

“I’ve taken care of Jim for many years,” says Henry L. Weiner, M.D., Landsness’ cardiologist. “He has always refused to constrain his life and work because of his heart disease. He’s fearless about medical technology. He embraced ICD therapy for ventricular tachycardia when it was new and ‘cutting edge,’ because he understood that it would be safer and allows him to be more active than traditional drug therapy.

“I think he’s had a similar attitude toward LVAD therapy. He sees the glass half full. It’s just how Jim is.”

Heart failure affects nearly 5 million Americans. Patients with advanced heart failure have often reached their maximal doses of medications and may have undergone coronary bypass or valve operations. The LVAD can represent a bridge to heart transplantation for some patients but can also represent their last opportunity for an improved quality of life without a transplant.

The current LVAD pumps have only one moving part and are designed to work for many years.

At the time of surgery, an LVAD is attached to the patients’ heart and aorta, and the pump is placed in the patient’s chest/upper abdomen. A controller connects the device via a driveline, which exits from the right upper abdomen. The patient wears the controller on a belt. Batteries weighing about a pound power the system.

Heart failure patients like Landsness who need the newest generation of LVADs now can stay home in Delaware for treatment, avoiding stressful and costly trips to Baltimore, Philadelphia or New York for the procedure. Christiana Care’s Center for Heart & Vascular Health is the only center in Delaware to implant the life-saving heart pumps.

“It’s an exciting opportunity to bring more advanced therapies for heart failure patients in our community” says Mitchell T. Saltzberg, M.D., medical director of Christiana Care’s Heart Failure Program. “Patients in the region can stay at Christiana Care for the procedure and maintain relationships with their local physicians.”

Ray Blackwell, M.D., and Harsh Jain, M.D., members of the cardiac surgery team who performed Landsness’ surgery, say the program will benefit Delaware patients and their families.

“This is a major opportunity for patients in Delaware with end-stage heart failure,” Dr. Blackwell says. “Short of transplant, the LVAD represents the most advanced technology for the treatment of heart failure.”

“It supplements medications and other heart failure-related devices,” adds Dr. Jain.

The average hospital stay for patients who receive LVADs is 16 days.

“The Heart Failure Program’s multi-disciplinary approach gives patients access to a full spectrum of providers, from cardiologists, surgeons and nurses, to therapists, pharmacists and behavioral health specialists, as the patient undergoes this complex procedure,” Dr. Saltzberg says.

“Many patients may not even be aware of this treatment option, or realize that they do not have to be critically ill to qualify for the procedure,” he says. “We’re very proud of the enthusiasm and support of Christiana Care Health System as we embark on this new program. This is truly a life-changing pump. At the end of the day, we want to provide outstanding care to the patients in our Heart Failure Program.”

“Everyone at Christiana Care is just fantastic,” Landsness says. “That goes for my cardiologist, the Heart Failure program staff, the OR nurses and the nurses on the floor. Even the cleaning staff. Everyone was just amazing.”

Wilmington Hospital room numbers and naming conventions will change on Dec. 13. This chart depicts the fundamental logic to the renaming. For example, the north units align with the north end of the facility, closest to the Brandywine River. (Click to view full-size chart.)

Christiana Care’s expansion and renovation of its Wilmington Hospital campus—a $210 million investment that helps us continue building a healthy community for our neighbors in the city of Wilmington—is continuing on schedule thanks to the hard work of many. Soon, a different type of construction milestone will take place, inside the walls of the hospital. As part of our transformation, the naming conventions on unit floors and room numbers will change on Tuesday, Dec. 13. Telephone numbers will not change.

John G. DiGiovanni

Christiana Care Senior Systems Engineer John G. DiGiovanni is a key member of one of the nation’s cutting-edge health system information technology departments. But it is his dedication to keeping amateur radio technology alive as an emergency option when disaster strikes that helped make DiGiovanni a Christiana Care Jefferson Award winner.

Amateur radio has garnered devoted hobbyists since 1909 and remains a popular hobby today. DiGiovanni started pursuing his ham radio operator hobby in the early 1990s. His interest included doing compassionate acts such as helping the Red Cross keep families informed about loved ones during natural disasters.

He approached Christiana Care’s Volunteer Office in 2001 with the idea to develop amateur radio hobbyists into a group that would provide backup communications to Christiana Care and other non-profits. That was the beginning of today’s Christiana Amateur Radio Emergency Services (CARES) team.

Today DiGiovanni still recruits volunteers, makes presentations and conducts training to help maintain a strong volunteer group at Christiana Care comprising more than 25 members. The CARES team has built two fully operational radio stations and repeaters, participates in emergency drills throughout our community, and meets regularly. Throughout the year they provide support to numerous organizations, including the American Heart Association and the March of Dimes. He often speaks on amateur radio topics at other hospitals in the region.

The Jefferson Awards program is a prestigious national recognition system established in 1972 to honor individuals for excellence in community and public service in our nation.

In 2010, Christiana Care started a related, system-wide recognition program to honor individuals who volunteer and provide community service beyond the work they do each day as employees or volunteers for the health system. These award winners help to define the concepts of service, leadership and caring, and bring our core values to life.

Of the award winners recognized throughout the year, one represents Christiana Care annually in Washington, D.C., for the announcement of the national winner.

Linda Sydnor, GCNP

Geriatric Clinical Nurse Specialist Linda Sydnor’s passion as an advocate for the elderly doesn’t stop with the end of her shift on the 6A Acute Care for the Elderly (ACE) unit at Christiana Hospital.

In 2010, Sydnor was named the Alzheimer’s Association’s Volunteer of the Year. She has been a volunteer for the Delaware Chapter of the Alzheimer Association and the Walk to End Alzheimer’s Disease Committee since 2006.

This year she chaired the annual Walk to End Alzheimer’s Disease Committee, a 10-month commitment to recruiting volunteers and walkers, raising funds and generally helping organize event.

She also serves as team captain of the ACE Angels walking team, which holds monthly events to raise money to fight Alzheimer’s disease. This year the ACE Angels surpassed their $4,000 goal.

Sydnor was nominated for the Jefferson Awards by her supervisor Vicki Schad, RN, MSN-BC, who describes her as “someone who is dedicated and passionate about providing the highest quality of care to the elderly population—whether they are on the ACE Unit or in the community.”

The Jefferson Awards program is a prestigious national recognition system established in 1972 to honor individuals for excellence in community and public service in our nation.

In 2010, Christiana Care started a related, system-wide recognition program to honor individuals who volunteer and provide community service beyond the work they do each day as employees or volunteers for the health system. These award winners help to define the concepts of service, leadership and caring, and bring our core values to life.

Of the award winners recognized throughout the year, one represents Christiana Care annually in Washington, D.C., for the announcement of the national winner.