Our Magnet Journey at Sinai Hospital

In April, Sinai Hospital of Baltimore received the American Nurses Credentialing Center’s highest honor for nursing excellence, making it the first and only community/teaching hospital in Maryland to carry the elite "Magnet" designation.

After an intense application and review process, Sinai Hospital joined a distinguished list of Magnet hospitals nationwide, including Duke University Hospital in Raleigh, North Carolina; Mayo Clinic College of Medicine in Rochester, Minnesota; and the Cleveland Clinic. The Magnet Recognition Program® designation is held by only 287 hospitals of the more than 6,000 eligible health care organizations in the country.

The Magnet Recognition Program®, developed in 1990 by the American Nurses Credentialing Center, recognizes excellence in quality patient care, nursing leadership and innovations in professional nursing practice. Additionally, Magnet hospitals demonstrate adherence to standards for improving the quality of patient care, leadership of the nurse executive in supporting professional development of every nurse, and incorporating cultural and ethnic diversity of patients and their families.

Sinai continuously recruits highly skilled and compassionate nurses to join our team. To listen to our nurses describe what it means to work in a Magnet hospital and be part of the Sinai family, check out this recently produced video of our Magnet announcement celebration.

Hip Resurfacing at the Rubin Institute for Advanced Orthopedics at Sinai Hospital

An exciting alternative to standard total hip replacement surgery is now available at the Rubin Institute for Advanced Orthopedics (RIAO) at Sinai Hospital. Hip resurfacing has recently been approved by the Food and Drug Administration for use in the United States. Now, patients at the RIAO suffering from hip pain and arthritis can benefit from this treatment approach.

Arthritis of the hip has several different causes and almost all of them can be treated with hip resurfacing. Primary osteoarthritis, the most common form of arthritis, is especially well suited for this new technique. Dysplasia patients, who suffer from an abnormal hip anatomy that leads to increased “wear and tear,” also are prime candidates for the resurfacing technique. Those with avascular necrosis or osteonecrosis, which results from altered blood flow to the hip joint, can also benefit from this technique.

Until recently, orthopaedists were recommending standard total hip replacement for almost all later stage surgically treated hip problems. These hip replacements require removing a large amount of bone from the femur or thigh-bone and inserting a long metal stem into the center of the remaining bone.

“Hip resurfacing, on the other hand, preserves the femoral bone, and requires surgeons to remove only the top centimeter of the head of the thigh-bone,” says Michael A. Mont, M.D., director of the RIAO’s Center for Joint Preservation and Replacement. “Patient recovery time can be fast and patients often walk normally and participate in high-level activities sooner. And if future revision surgery is required, it often is a less complex and traumatic procedure.”

One recently published gait study at the RIAO showed that hip resurfacing patients had a more normal speed and other walking parameters when compared to traditional hip replacements. Because the implant used in a hip resurfacing more closely matches the patient’s bone size, it may allow for more stability than traditional hip replacements.

“Traditionally, only the ball of a hip replacement was made from metal, and the socket was lined with a plastic cup, which often wore out over the course of many years,” says Ronald E. Delanois,
M.D., an orthopaedic surgeon at the RIAO.With new metallurgy and manufacturing techniques, both components are made of highly polished metal.

“The benefits to patients who undergo the hip resurfacing procedure are clear,” says Barry N. Waldman, M.D., director of the Center for Joint Preservation and Replacement at the RIAO. “The implant’s size, surface, and bone-sparing ability makes it an excellent choice for young, active patients.”

“Hip resurfacing may be a dramatic breakthrough for many patients. We must remember that standard total hip replacements also function well and patient selection for this new procedure is important,” says Wayne Leadbetter, M.D., an orthopaedic surgeon at the RIAO.

For more information about hip resurfacing procedures performed at Sinai Hospital’s Rubin Institute for Advanced Orthopedics, call 410-601-WELL (9355).

Northwest Hospital kitchen moves outside

Imagine the inherent difficulty of preparing, delivering and serving 10,000 meals for hospital patients, staff and visitors each week.

Now imagine attempting this feat outside under a 30-foot by 40-foot enclosed tent, in 20 degree weather, with a snow storm bearing down on you.

Such has been the challenge facing Northwest Hospital Dietetic Services employees for the last few months during a complete ceiling-to-floor renovation of the hospital's kitchen. Rather than remain inside and try to work around the construction for a year, hospital executives boldly decided to relocate the entire food preparation operation outdoors, enabling crews to complete the renovation in just three months. Such a move has never before been attempted by a hospital the size of Northwest.

“We had a plan, but we didn’t know if it would work,” says Dietetic Services Director Sam Borozzi. “We are learning as we go.”

Working without any sort of blueprint forces the staff to make adjustments on the fly. First they had to find a tent that would withstand unpredictable fall weather. They had to figure out how to run water and electrical service to the tent. The start was delayed several weeks because of problems getting permits.

“We even had the Baltimore County Health Department scratching their heads to make sure all the permits and licenses are the way they’re supposed to be,” Sam says.

The switchover took place overnight on October 18 and went fairly smoothly. To get inside the tent, you enter through a covered walkway extending out to the ground floor rear entrance. Inside the tent, it’s a flurry of activity. There are separate stations for steamers, ovens and grills and a cold food preparation area where salads are assembled. Because the equipment takes up so much room, the spaces between are cramped. There’s no room – or patience for – people standing around. Collisions were a daily occurrence in the beginning, and though Sam expected to lose some staff, no one has walked off the job.

Because the distance traveled is farther and involves a short walk outside, patient food trays are assembled inside the tent using a new Heat On Demand system, which warms plates to 250 degrees. It came in handy when the nearest patient tower elevator went out of service shortly after the move and employees had to truck their delivery carts through the ER-7 entrance, even in the rain.

“I had to run out and buy a bunch of ponchos for them,” says Digna Planas, assistant director of Dietetic Services.

Sam credits the Dietetic staff with being resilient in the face of adversity.

“They have really adapted well,” Sam says. “The tent has actually had the reverse effect - they’ve really come together as a team.”

Another major hurdle – keeping frozen food frozen and perishable food cold. A giant trailer-size refrigerator and freezer are parked outside the tent. Early on, tent employees were getting soaking wet running back and forth in the rain. After Tropical Storm Gustav hit, Facilities workers fashioned a temporary, covered walkway to protect the staff from the elements. The freezer sits several feet off the ground, so a wooden ramp and loading dock had to be constructed.

Jerrod Harris is the storing clerk for Northwest. His office these days – when it’s dry – is a wooden picnic table. Jerrod is responsible for ordering perishable foods, keeping inventory, unloading the delivery trucks when they arrive and storing everything in a manner so that the kitchen staff has quick access. Tempers can flare when it’s 80 degrees and there are 500 boxes of frozen meat to store in an already cramped and claustrophobic freezer.

“It’s been a trial-and-error situation,” Jerrod says. “No one has worked in this kind of situation before. It’s much better now that a system is in place.”

Once complete, the new kitchen will feature an open layout that makes it easier to navigate, with shorter walls and more space. A new, environmentally friendly water filtration system will better separate grease, and the staff will have the ability to do room service for patients.

Though he is eager to move back inside, Jerrod realizes that too will be an adjustment.

“You just take it one day at a time,” he says.

Maternal-fetal specialists help ease worry of high-risk pregnancies

Expectant mothers are filled with excitement and joy at the prospect of welcoming a new member to the family. Nurseries are prepared and baby showers are planned with the expectation that the pregnancy will go smoothly. But what should you expect if your pregnancy isn’t what you are expecting?

Turning to the experts at the Institute for Maternal-Fetal Medicine at Sinai Hospital of Baltimore can ease a mother’s mind.

A high-risk pregnancy is one in which some condition puts the mother, the developing fetus, or both at higher-than-normal risk for complications during or after the pregnancy and birth.

Certain factors can limit the likelihood of having a healthy, full-term pregnancy. These include the mother’s age; medical conditions such as high blood pressure, obesity and a history of infertility; and whether there is more than one embryo.

The goal is to keep these bundles of joy from arriving in the world too early. The No. 1 reason babies die is prematurity, says Pedro P. Arrabal, M.D., the director of Sinai’s Institute for Maternal-Fetal Medicine (click here to see photos). Maternal-fetal obstetricians like Arrabal specialize in high-risk pregnancies.

“One of our major roles is knowing when to deliver,” Arrabal says. “We are aggressive in trying to stop premature labor. Our job is to make sure pregnancy can safely be continued for mother and fetus.”

Nationwide, there are 1,400 obstetricians who subspecialize in maternal-fetal medicine. And three of them are at Sinai. Most high-risk pregnancies are co-managed with the mother’s regular obstetrician.

With proper guidance and prenatal care, risks can be minimized. While age is a common risk factor, Arrabal delivered a healthy baby for a 51-year-old mother, and has successfully delivered babies for many women in their late 40s.

“We are seeing more and more older moms,” he says.

As diabetes rates sore, Arrabal has also seen more diabetic patients. There is an American Diabetes Association–accredited obstetric program at Sinai and a diabetes educator whose sole responsibility is working with pregnant women.

“Some community hospitals can’t handle these complicated cases,” Arrabal says. “We have an excellent NICU (Neonatal Intensive Care Unit), major medical subspecialties and pediatric subspecialties. We have extensive support for mom and baby.”

Jacqueline Eldridge Wheeler, R.N., is the patient care manager of Labor and Delivery at the BirthPlace at Sinai. She says the nursing staff prepares extensively for high-risk pregnancies. There are meetings, often involving the mother, and the teams at Sinai emphasize communication.

“The nurses are constantly educating themselves,” Eldridge Wheeler says. “And we’re communicating with our mothers so that they know what to expect and they feel comfortable knowing that we’re experienced with high-risk pregnancies.”

Plus, the sophisticated machines and technology available at the BirthPlace at Sinai make it easier to handle complications.

“We are able to react immediately if we’re not already there at the bedside,” she says. “We can handle multiples or pregnancies with complications in order to make labor and delivery go as smoothly as possible.”

Arrabal, who also speaks Spanish, encourages patients to ask questions throughout their pregnancy, providing his e-mail and business card to expectant mothers. “There’s a lot of bad information on the Internet. I tell my patients to contact me with questions or concerns.”

The institute also provides preconception counseling. Genetic counselors are available to discuss testing to see whether the parents are carriers of disorders such as cystic fibrosis and Tay-Sachs disease. The institute, located at the Louis and Henrietta Blaustein Women's Health Center at Sinai, also offers the latest in tests to determine whether the baby is healthy or has potential birth defects.

“We want to give an early developing embryo the best environment possible,” Arrabal says.

Eldridge Wheeler says she’s also proud of Sinai’s programs specifically developed to interact with women following the delivery of their baby. This includes screenings for postpartum depression.

“Having a healthy baby is just the beginning,” she says.

For more information about the Institute for Maternal-Fetal Medicine, call 410-601-WELL (9355).

Mayor Sheila Dixon launches TreeBaltimore Program at Sinai Hospital

Sinai Hospital is pleased to be the first institution to partner with Baltimore city to launch the TreeBaltimore program. Mayor Sheila Dixon and other elected officials were on hand Thursday, December 4, to kick off this program.

As the first business to participate, Sinai Hospital is planting 30 trees around its campus to help increase the neighborhood tree canopy. Baltimore city will also plant 30 trees on Lanier Avenue in the Cylburn community, located directly around Sinai Hospital. In addition to planting the trees, Sinai Hospital has agreed to take care of the initial maintenance of the trees planted by Baltimore city.

TreeBaltimore is a Baltimore city program with a goal of doubling the city’s tree canopy.

“Sinai Hospital is fully committed to being an industry leader in developing eco-friendly practices,” said Neil Meltzer, president and chief operating officer. “We are excited to partner with Baltimore city to help promote the greening of the city.”

Baltimore Mayor Sheila Dixon speaks at Sinai Hospital about new Medical Assistance for Families program

Baltimore Mayor Sheila Dixon, City Council President Stephanie Rawlings-Blake and other elected officials joined Sinai Hospital President Neil Meltzer for a recent press conference urging city residents to enroll in a new state program that expands the number of people who are eligible for health coverage under the Medicaid program. More than 19,000 Marylanders have enrolled in the new Medical Assistance for Families program, which provides comprehensive health care to eligible Maryland parents and other family members caring for children.

Maryland Hospital Association President and CEO Carmela Coyle hosted the press conference at Sinai Hospital's ER-7. Dixon and Rawlings-Blake unveiled a new radio ad they cut together.

Since Gov. Martin O’Malley’s Working Families and Small Business Health Care Coverage Act took effect on July 1, more than 19,000 Marylanders have enrolled in the new Medical Assistance for Families program, which provides comprehensive health care to many Maryland parents and other family members caring for children. The radio ad is sponsored by the Maryland Health Care for All! Coalition and Baltimore HealthCare Access.

Tomorrow, Dixon returns to Sinai Hospital for another press conference, this time to kickoff the city's new TreeBaltimore program. As the first business to participate, Sinai Hospital is planting 30 trees around its campus to help increase the neighborhood tree canopy. For more information, call Ryan Nawrocki in the LifeBridge Health Marketing department at 410-601-5026.

Hand Washing

Want to keep from catching the common cold, strep throat and influenza this winter? You can stock your medicine cabinet with the best homeopathic remedies and swallow a dozen vitamins a day. But the infection control experts agree: The easiest, cheapest and most effective way to keep the bugs at bay is thoroughly and frequently washing your hands.

“The hands are the perfect vehicle for transmitting all types of germs. So it only makes sense that proper hand hygiene is the simplest, most effective way of preventing the spread of infection,” says Jackie Daley, director of Infection Prevention and Control at Sinai Hospital of Baltimore.

Turns out mom was right: Clean hands are one of the most important ways to avoid getting sick and spreading germs to others. The lesson is especially true for young children who are at greater risk of contracting influenza, or the flu. The Centers for Disease Control and Prevention (CDC) estimates nearly 22 million school days are lost each year to the common cold. However, when children practice proper hand hygiene, they miss fewer days of school. Another CDC study found that children under age 5 who regularly wash their hands with soap are 50 percent less likely to contract pneumonia, which can lead to death.

Hand washing also lessens the risk of acquiring Methicillin-resistant Staphylococcus aureus, or MRSA, a type of bacteria that is resistant to some of the most commonly prescribed antibiotics. The disease most commonly infects patients with weakened immune systems in hospitals, nursing homes and other health care centers, but outbreaks of MRSA in schools and other community settings are on the rise.

“We panic when we get a letter from our children’s school that a student has head lice. But tell them about MRSA and they look surprised – just because we can’t see it,” Jackie says. “As with head lice, an ounce of prevention can go a long way to stopping the spread of the flu, MRSA and many other communicable diseases.”

Proper technique is key
Scared yet? Good. Now you’ve committed yourself to taking action and practicing good hand hygiene. But even the most religious hand washers can leave themselves exposed to germs by using the wrong disinfecting agents and poor technique. Running your hands under cold water “is just giving the germs a quick cool-down shower. We might as well not bother washing if we don’t do it the right way,” Jackie says.

To wash your hands the right way, begin by removing any heavy jewelry. Use soap and warm water. Rub your hands together hard for at least 15 seconds – about the time it takes to sing “Happy Birthday” twice (in your head, please). Rub your palms, fingernails, in between your fingers and the backs of your hands up to the wrist. The water should be warm but not too hot.

“The bugs are smarter than we are. They hide in places we don’t expect to find them, especially under the fingernails and on the back of the hands,” Jackie says.

Use your common sense to decide when it’s appropriate to wash. The CDC recommends washing after you use the bathroom and before and after you eat. Wash your hands when you take out the trash, change a diaper, visit a sick person or play with a pet.

“When in doubt,” Jackie says, “wash.”

Alcohol-based hand sanitizers and lotions also are an effective substitute for soap and water provided the alcohol content is 63 percent or more. Hospital patients should request a pump if there isn’t one in their room. In a hospital setting, doctors and nurses routinely come into contact with many types of bacteria and viruses, including MRSA. Health care providers are supposed to disinfect their hands before touching any equipment or patient, but national studies show a 40 percent compliance rate.

To reduce the risk of spreading MRSA and other infections, many hospitals, in concert with the CDC, are mounting public awareness campaigns encouraging patients to challenge health care providers who fail to clean their hands or wear gloves before engaging in any patient care activities.

“Patients need to take an active role in their care. They should not be afraid to ask their providers to wear gloves or wash their hands,” Jackie says.

Germaphobes beware
Of course, even if you wash your hands 100 times a day, it won’t matter if someone sneezes or coughs in your face. Germs can travel three feet or more when we sneeze and cough. That’s why the first lesson many kindergarteners learn (if they haven’t already) is to cover their mouth and nose.

Most of us also learn at an early age to keep tissues handy when we’re sick and cough into our elbow instead of our hands. But the best way to keep from passing your germs on to others is to stay home when you’re sick. Avoid shaking hands or touching others if you must venture out.

“Infection prevention is everyone’s business. We all have a role to play,” Jackie says.