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Medical DialogueKEEPING PHYSICIANS ABREAST OF THE LATEST NEWS AND INFORMATION AT DIGNITY HEALTH – ST. MARY MEDICAL CENTERFALL  Understanding Our Journey as a High Reliability OrganizationNicholas Testa Chief Physician Executive Southern California DivisionWe are all working together to become a High Reliability Organization, one which prioritizes patient safety in our ever changing environment, but many may still ask ‘what does High Reliability really mean?’ A High Reliability Organization, or HRO, has fewer than its share of errors and events by prioritizing safety and adopting a culture where we consistently do the right thing for our patients and sta. We empower our people to ask questions, we organize our leadership around safety activities, and we all commit to studying and improving our processes to become safer. Other organizations, such as the airline industry, have become HROs by having every member of the team adopt safety as their number one priority. It is not enough for us to say we are going to be safe. Safety is everyone’s responsibility, and we all must align around it to truly advance our culture.To date, the progress we have made is nothing short of inspiring. Our HRO initiative, Safety by Choice, Not by Chance, is being rolled out at all  of our Southern California Division hospitals and while hospitals are at various stages of implementation, we are seeing a growing focus around safety. On a daily basis, we exemplify an increased mindfulness on patient safety, a closer collaboration across disciplines, and an atmosphere of trust that heightens our day-to-day sensitivity to operations. To continue on our HRO journey, we are aiming to have every physician participate in High Reliability behaviors and tools training. For some this will be the rst time they are seeing this material and for others this will be a refresh of training they did years ago. But for all of us, it will be yet another important step forward towards creating a consistent culture of safety. Simultaneously, we are regularly sharing stories that prioritize safety and rolling out leader tools that augment our team safety huddles and rounds.I am grateful for your partnership and enthusiasm. I believe our collective commitment will lead to our long-term success, as we strive to make our division’s hospitals the safest in the nation by consciously practicing High Reliability practices and encouraging our teams to do the same. Thank you for doing your part on our journey to becoming highly reliable.

2 St. Mary Medical DialogueClinical Documentation Tips: Sepsis and Severe SepsisThe importance of consistent and complete documentation in the medical record is critical to achieve accurate coding that supports the length of stay, resource consumption, severity of illness, and risk of mortality for that patient stay. The Clinical Documentation Specialists CDS are here to assist you to achieve documentation specicity that supports faster and ecient medical solutions. This process is designed to reect quality and accuracy, while capturing accurate acuity. Please see these documentation tips for Sepsis and Severe Sepsis.Coded as Sepsis:•Specify Sepsis  Examples: Bacteremia with Sepsis, UTI with SepsisNot Coded as Sepsis:•Systemic Inammatory Response Syndrome SIRS•Urosepsis Coded as UTI•Bacteremia•Sepsis Syndrome SEVERE SEPSISWhat needs to be documented? Correctly documenting severe sepsis will more accurately reect an increased severity of illness as well as supporting the length of stay, resource consumption, and risk of mortality for that patient stay.Severe sepsis is dened as sepsis  organ dysfunction. Sepsis criteria Infection plus  SIRS criteria must be met before severe sepsis can exist. Providers must clearly conrm or link the underlying organ dysfunction is associated / caused by Sepsis. Sepsis with associated acute organ dysfunction include: •Encephalopathy metabolic, septic, etc. •Acute Respiratory Failure / ARDS •Acute Renal failure / AKI with or w/o ATN •Anuria or Oliguria •Hepatic Failure •Disseminated Intravascular Coagulopathy DIC •CHF •Hypotension / tachycardia •Lactic Acidosis •Hyperbilirubinemia Documentation linkage examples: •AKI due to Sepsis •Sepsis related Hyperbilirubinemia •Sepsis induced Metabolic Encephalopathy •Sepsis causing Acute Resp Failure •Sepsis with associated OliguriaPlease Note: In responding to Clinical Documentation Improvement (CDI) Clarication or Coding Query requests, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular response is desired or expected.Thank you for ensuring clinical documentation is accurate to continue providing optimal care for our patients. Sepsis Statistics •- million cases per year•At least  million deaths per year• in  deaths worldwide is associated with Sepsis• of Sepsis cases occur outside of the hospital setting• are children under •Sepsis is always caused by an infection like pneumoniaThank you for all you do to prevent sepsis and ensure the safety of our patients.

St. Mary Medical Dialogue 3Welcome New Physicians to the St. Mary Medical Center FamilyAnesthesiologyJustin Kirzner, MDDiagnostic RadiologyAlexander Le, MDGastroenterologySeper Dezfoli, MDInternal MedicineOlga Anikina, MDDebby Chung, MDReza Ghetmiri, MDWishanth Gooneratne, MDAmit M. Parekh, MDMarian Varda, DOInterventional RadiologyIbrahim Idakoji, MDNephrologyLei Win, MDNeurologyAmy Malphrus, MDVesna Micic, MDDouglas Porter, MDTodd Raleigh, MDGreg Schaublin, MDLarry Simmons, DOJessica Yen, MDOphthalmologyLing Bei, MDPsychiatryMonique Harrison, MDJoseph Mirkovich, MDDonghui Wei, MDPhysician ResourcesLoan Repayment for Educational DebtCalHealthCares administers loan repayment on educational debt for California physicians and dentists who provide care to Medi-Cal patients, which represent one-third of Californians and half of the state’s children. Eligible physicians can apply for up to  in loan repayment in exchange for a ve-year service obligation. Eligible dentists can apply for a loan repayment up to  in exchange for a ve-year service obligation or a Practice Support Grant up to  in exchange for a ten-year service obligation. For details, visit www.phcdocs.org/Programs/CalHealthCares.Top CDI Query Response Achievers High physician response rates help accurately reect patient severity of illness and intensity of service. We thank the following physicians for their diligence and commitment to St. Mary Medical Center. Criteria for Top Clinical Documentation Improvement CDI Query Response Achievers: Only physicians with three or more queries and an answer rate of – are included. Below are the top achievers for June, July and August . Congratulations on a job well done!Fataneh Amidi, MD, Obstetrics & GynecologyOlga Anikina, MD, Internal MedicineChristina Arcuri, MD, Internal Medicine David Cao, DO, Internal Medicine Cynthia Chao, DO, Obstetrics & GynecologyDavid Chen, MD, Neurology, Jose L. De La Rosa, MD, Obstetrics & GynecologyMamak Eatesam, MD, Internal MedicineHripsime Gharibjanyan, MD, Internal MedicineRasam Hosseinian, MD, Internal MedicineJohn Issa, MD, Internal MedicineRajveer Joea, MD, Internal MedicineXibel Liu, MD, Internal Medicine Deborah Milligan, MD, Critical Care Medicine Rabin Mizrahi, MD, Obstetrics & GynecologyVisal Nga, DO, Internal MedicineMinh Nguyen, MD, Cardiovascular DiseaseIris Partovi, MD, Internal MedicineRonald Philipp, DO, Family MedicineJohn Pinches, DO, Obstetrics & GynecologySanam Pournak, MD, Internal MedicineTara Reid, DO, Family Medicine Bradley Roth, MD, Critical Care Surgery Fazeel Shah, DO, Internal MedicineVannarith So, MD, Internal Medicine Serap Sobnosky, MD, Cardiovascular Disease Ravi Solanki, DO, Internal MedicineHenry Su, MD, Infectious DiseaseJoanna Tan, MD, Internal Medicine Charis Tjoeng, DO, Infectious DiseaseChok Wan, MD, Internal MedicineJohn Young, DO, Family Medicine

4 St. Mary Medical DialogueCALL FOR ARTICLES: We encourage members of the St. Mary Medical Staff to submit information or articles for publication. We welcome your input! Issues are published quarterly (Summer, Fall, Winter, Spring).Article submissions are due to the Communication Department a month in advance of the next quarterly issue.Please call Tracie Gipson, Medical Dialogue Editor at 818.522.4574 or email TracieCheesemangipson@CommonSpirit.org.EDITORIAL TEAMChuck Anderson, MDChief Medical OfficerTracie GipsonMedical Dialogue EditorBonnie MathewsMedical Staff CoordinatorDonna GoestenkorsInterim Director, Medical Staff Administration1050 Linden Avenue • Long Beach, CA 90813 | 1.888.4STMARY (1.888.478.6279) | dignityhealth.org/stmarymedicalOur values are the core principles that enable us to deliver humankindness.CommonSpirit Values: Compassion | Inclusion | Integrity | Excellence | CollaborationPhysicians in the NewsWe’d like to thank and recognize the following physicians who were recently featured in the online consumer health blog Eat This, Not That!Ali Jamehdor, DO Medical Director, Emergency Department, addressed correct usage of Ibuprofen, which should be taken to reduce fever, and to help reduce pain associated with dental work, headache, muscle ache and sore throat.Nikhil Kapoor, MD, FACC, FSCAI, Cardiologist, was featured in an article about the benets and dangers of taking nutritional supplements.Sepehr Lalezari, MD, General Surgeon and Gastrointestinal Specialist, was featured in an article about the causes and treatments for ulcers.Kanchana Viswanathan, MD, Internal Medicine, was interviewed in an article about the endocrine system and common signs of endocrine imbalance.Providing Preventive Tips Via Social MediaThank you to the following physicians who discussed important medical issues and oered tips to benet those who follow us on social media.Watson Desa, MD, Cardiologist, discussed an easy way to remember preventative heart disease tips by following the acronym SMART which stands for: Symptoms, Medications, Activity, Regular Weight Monitoring, and Toss the Salt.William Kim, MD, Orthopedic Surgeon, discussed the advancements and benets of joint surgery, including the possibility of returning home in a matter of days.Mark Lee, MD, Medical Director of Electrophysiology, discussed signs of an abnormal or irregular heart rhythm, most commonly atrial brillation or A-b, which can cause strokes.Shafagh M. Monazzam, MD, Orthopedic Surgeon, discussed the best time to schedule a necessary hip or knee replacement, which is sooner rather than later for an optimal recovery.Serap Sobnosky, MD, Medical Director, Women’s Heart Center, spoke about the importance of a healthy lifestyle for good heart health and about St. Mary’s excellent team of physicians and heart services.Click on physician name to view.