medicalstaffnewsMONTHLY NEWS FOR PHYSICIANS October 2012

Affiliated with The University of Texas HealthScience Center at Houston (UTHealth)

Medical School

The Center for Advanced Heart Failure at Memorial Hermann Heart & Vascular Institute-Texas Medical Center (HVI) received interim approval late last month to begin performing heart transplants, marking a significant milestone for the new program. The United Network for Organ Sharing (UNOS) granted approval on September 21, and the team now has full authority to perform all aspects of heart transplant care, complementing Memorial Hermann’s existing kidney, kidney-pancreas, liver and intestinal transplant programs. “We’ve assembled a world-class team to help treat those who suffer from advanced heart failure,” said Paul O’Sullivan, chief executive officer of the HVI. “This is another extraordinary opportunity for us to give many of our patients a second chance at life.” UNOS is the private, nonprofit organization that manages the nation’s organ transplant system under contract with the federal government. All organ transplantation programs must undergo a stringent application process and review from UNOS before receiving approval to perform transplants. Hospitals must show they have all the appropriate resources, including physicians experienced in transplant and the multidisciplinary team required to care for transplant patients pre- and post-transplant, including specially trained nurses, transplant coordinators, physical therapists, social workers, dietitians, bioengineers and much more. The Center for Advanced Heart Failure opened in March, and is led by Igor Gregoric, M.D., chief, Surgical Division, and Biswajit Kar, M.D., chief, Medical Division. Pranav Loyalka, M.D. serves as the associate chief, Medical Division and Sriram S. Nathan, M.D. is

the director of Cardiogenic Shock. The multidisciplinary Center is also staffed with heart transplant and ventricular assist device (VAD) coordinators, social workers, dietitians, circulatory support staff and bioengineers. The Center’s outpatient clinic is currently located in the University of Texas Professional Building (UTPB) and the permanent clinic will open next year in the Memorial Hermann Medical Plaza. The team has already begun to list patients who are candidates for heart transplant, and they are awaiting the appropriate match to perform their first transplant

which could come any day. “There has been an incredible collaboration across disciplines to make this happen,” said O’Sullivan. “From nursing, radiology, anesthesia, pathology, pulmonary services, patient business services, physical therapy, just to name a few, everybody has worked very hard to ensure we have defined processes for efficiency and patient safety. We are ready.”

Heart Transplant Program Gets Green Light from UNOS

For the first time in its history, the Memorial Hermann Heart & Vascular Institute–Texas Medical Center now has the ability to perform life-saving heart

transplants. To coordinate this effort, the HVI established the Center for Advanced Heart Failure, which is led by Igor Gregoric, M.D., chief, Surgical Division,

Biswajit Kar, M.D., chief, Medical Division, and Pranav Loyalka, M.D., associate chief, Medical Division.

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Dr. Colasurdo Named UTHealth President Sole Finalist

The University of Texas System Board of Regents on Sept. 26 named Dean Giuseppe Colasurdo, M.D., the sole finalist for the presidency of The University of Texas Health Science Center at Houston

(UTHealth). The board unanimously approved the decision at a special called board meeting in which candidates were interviewed. Dr. Colasurdo has served as the interim president of UTHealth since former president Dr. Larry Kaiser stepped down last year. An internationally known researcher and pediatrician, Dr. Colasurdo joined the faculty of the UTHealth Medical

School in 1995 and was named chair of the division of Pediatrics in 2005. In 2007, he became dean and H. Wayne Hightower Distinguished Professor in the Medical Sciences at the Medical School. “Dr. Colasurdo is a remarkable clinician and educator, and we are confident he is the right choice to lead UTHealth to even greater levels of teaching, research and medical care,” said Regents’ Chairman Gene Powell. “Selecting a Campus president is one of the most important decisions regents make. Dr. Colasurdo was chosen from an outstanding group of candidates and, on behalf of the board, I would like to thank all the candidates who took part in the process.” A native of Morrone del Sannio, Italy, Dr. Colasurdo completed his undergraduate education at Liceo Scientifico Galileo Galilei in Pescara, Italy. He earned his medical degree

from G. D’Annunzio School of Medicine in Chieti, Italy. He came to the United States in 1988 and is a U.S. citizen. “We are extremely happy with the board’s decision to name Dr. Colasurdo as sole finalist for this critical position. Our advisory committee, composed of faculty, staff, alumni and community leaders, performed admirably in reviewing an exemplary pool of candidates and narrowing the field to the very best in the fields of medicine and health administration,” said Kenneth Shine, M.D., executive vice chancellor for health affairs and chair of the presidential search advisory committee. “We are grateful to the committee for its hard work and dedication.” Under state law, university governing boards must name finalists for a presidency at least 21 days before making an appointment.

Campus Executives Selected to Present at National Conference on QualityNearly 2,000 healthcare leaders from across the country convened in Orlando last month for the University HealthSystem Consortium’s (UHC) Annual Conference, where two members of Memorial Hermann-Texas Medical Center’s executive team were invited to be a part of a small group of prestigious presenters. Their abstracts were two of only 70 presentations selected from more than 700 submissions. Craig Cordola, chief executive officer for the Memorial Hermann-TMC Campus, presented the abstract Structural Effectiveness: Two Institutions Cooperate with Giuseppe Colasurdo, M.D., president of The University of Texas Health Science Center at Houston (UTHealth). Amanda Spielman, chief of hospital operations, gave a presentation titled Connecting Data to Effect Change: Roadmap to Performance Improvement. Both presentations were given to large groups of physician, executive and nursing quality leaders from the nation’s most respected academically affiliated healthcare institutions as

part of the conference’s educational sessions, demonstrating best practices in strategic, operational and process efficiencies that drive quality and safety improvements. “I am extremely proud of our strong partnership with UTHealth, and it was an honor to present with Dr. Colasurdo on a topic that I feel so passionate about,” said Cordola. “It’s a priority for both of our institutions to work very closely with each other and the private physicians on our medical staff to provide the highest quality outcomes for our patients. It was a privilege to be able to share both our successes and challenges with such an esteemed group at the UHC conference.” Cordola and Dr. Colasurdo’s presentation addressed how a large academic hospital and a large medical school can align strategies despite a complex environment. Their abstract identified the key components to improving performance and clinical outcomes as having a unified vision, a strong partnership and mutually agreed-upon goals. Spielman, who counts responsibility

for the Mischer Neuroscience Institute (MNI) among her executive duties, illustrated how the MNI successfully utilized UHC data to identify opportunity and drive significant change in MNI’s performance improvement. Her abstract described how together with physician leadership and a multidisciplinary team from across the Campus, they were able to use data to develop the infrastructure, physician partnership and metrics to create a larger, more sustainable change in quality outcomes for the MNI. “Organizationally, we have put a tremendous amount of work into improving quality here, and our role as a member institution with the UHC is an important part of how we continue to make those improvements,” said Spielman. “It’s an invaluable tool for us to be able to look across our peer group and not only evaluate our own progress, but to learn from others. To be asked to showcase some of our successes is a great compliment to the efforts of our entire team.”

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Memorial Hermann-TMC Improves UHC Ranking for 2012

The Memorial Hermann-Texas Medical Center Campus has again been named among the nation’s top-performing academic medical centers for quality and accountability, improving from the No. 25 ranking in 2011 to No. 21, according to the University HealthSystem Consortium’s (UHC) annual list. To generate the listing, UHC assesses organizational performance from 116 major academic medical centers using measures developed by national organizations or the federal government across six domains of care – mortality, effectiveness, safety, equity, patient centeredness and efficiency. The organization examined clinical, operational and core measure data as well as information that is publicly reported through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to compile the rankings. The Memorial Hermann-TMC Campus made its first appearance on the list at No. 36 in 2006, a year after the list’s inception, and has been named every year since. “To improve our ranking from No. 25 to No. 21 among our peer group of 116 academic medical centers is an achievement we can all be proud of, particularly in this competitive environment where everyone continues to raise the bar in terms of quality and performance,” said Craig Cordola,

chief executive officer of the Memorial Hermann-TMC Campus. Cordola cited the strong partnership among the Campus, The University of Texas Health Science Center at Houston (UTHealth) Medical School and private physicians on the medical staff as a key driver of the improved ranking. In addition to the overall composite performance rating, each of the six domains was separately ranked. Our Campus scored No. 1 in the category of “equity” and No. 5 in the category of “effectiveness.” The “equity” category measures our ability to provide equitable care regardless of gender, race or socioeconomic status and the “effectiveness” category measures overall hospital readmission rates within 30 days after discharge. “The annual UHC rankings provide an excellent opportunity for us to measure our progress against our peers and identify opportunities to do even better,” said Jeffrey Katz, M.D., chief medical officer of the Memorial Hermann-TMC Campus. “Our improved ranking is a testament to the commitment of our physicians and caregivers to hold patient safety as our highest priority.” Out of the six domains of care that are measured, three of the domains account for 75 percent of the overall UHC ranking – effectiveness, safety and

mortality. “The Memorial Hermann-TMC Campus improved in all but one of the six domains from the previous year,” said Jo-Ann Kamencik, Ph.D., regional clinical effectiveness director for the Memorial Hermann-TMC Campus. “As other institutions continue to do better as well, it makes it significantly more difficult to make a big leap in the rankings. To move from No. 25 to No. 21 is quite an achievement.”

Domain 2011 Ranking 2012 Ranking

Mortality 44 32

Effectiveness 2 5

Safety 68 36

Equity 1 1

Patient Centeredness 60 56

Efficiency 49 17

Overall Ranking 25 21

“There has been a tremendous amount of work on behalf of the physicians and caregivers at the

bedside – particularly at the service line level – and because of that we

improved across the major domains,” said Kamencik.

She credits increased communication about performance

indicators for specific patient populations, and the diligence of those care teams to make improvements, for the better

outcomes.

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Brandy McKelvy, M.D., received the highest honors for sustainability at the University of Texas System Clinical Safety and Effectiveness (CS&E) Conference and Recognition Event in September, marking the third time in four years that a physician practicing at the Memorial Hermann-Texas Medical Center Campus was awarded at the annual event. Her presentation, titled Extension of the Spontaneous Breathing Trial (SBT) Protocol into Other ICU’s at Memorial Hermann-Texas Medical Center, outlined her work over the last three years with Respiratory Care Services that has ultimately led to hundreds of saved ventilator days. The conference, titled Building the Bridge: Maintaining Quality in the Face of Change, brought together hundreds of doctors, clinicians and students from across The University of Texas System’s health institutions. Now in its fourth year, the annual event is designed to encourage the transfer of learning and applicable best practices from across the UT System. Dr. McKelvy’s abstract bested close to 100 submissions from other graduates of UT CS&E courses

across the state, and her presentation was awarded in the “sustainability” category for “maintaining extraordinary results in the improvement of safety and quality,” according to conference officials. Dr. McKelvy’s work to improve the ventilator weaning process began in the MICU in 2009 as a project associated with her participation in the CS&E program sponsored jointly by The University of Texas Health Science Center at Houston (UTHealth) Medical School and Memorial Hermann-TMC. After experiencing initial success there, the SBT Protocol has been expanded to all seven adult ICUs on the Memorial Hermann-TMC Campus and is now being adopted across the System. The new protocol has resulted in more than 10,000 saved ventilator days over the last three years, leading to an overall decrease in the length of stay. The estimated cost avoidance for the period of July 2009 to July 2010 just for the MICU has been estimated to be more than $900,000. “It’s been very a very rewarding experience for me, and I am honored

that our work was recognized,” said Dr. McKelvy, who credits the nurses and respiratory therapists for their role in the initiative. “I cannot say enough about the wonderful team of nurses in the MICU and the amazing Respiratory Care Services team. I attribute our success to their dedication and professionalism. They have a commitment to the safety of our patients that is unparalleled.”

McKelvy Receives Sustainability Award at Annual UT Clinical Safety and Effectiveness Conference

Dr. McKelvy was recognized with top honors for sustainability at the annual UT CS&E conference this September

for her work in improving the ventilator weaning process in the MICU.

New State Law Mandates Vaccination PolicyIn an effort to reduce the incidence of vaccine-preventable illness, a new state law now requires all healthcare facilities to have a policy that identifies vaccine requirements for anyone who may come in contact with patients. The legislation went into effect Sept. 1, and applies to every healthcare facility that is licensed by the Texas Department of State Health Services. In response to the legislation, the Memorial Hermann Healthcare System recently implemented its Preventable Disease Immunization Policy. In accordance with the Centers for Disease Control and Prevention (CDC) guidelines, the policy requires that anyone who may come into direct patient contact be vaccinated or show immunity for hepatitis B, seasonal influenza, diphtheria, measles, mumps, rubella, pertussis, tetanus

and varicella (chickenpox). For those requesting exemption for conscientious objection, religious or medical reasons, signed exemption documents must be completed for review by Occupational Health. Any healthcare worker that is granted exemption will be required to wear personal protective equipment such as a mask and/or gloves at a minimum. “For physicians, the vaccination requirement will be similar if not exactly the same no matter where they practice in Texas,” said Danial Bravard, workplace safety officer for the System. “Newly credentialed physicians will be required to comply in order to receive clinical privileges, and for those physicians who are already credentialed, they will be required to show compliance as part of the re-credentialing process.”

Bravard and his team are working with administration across the System on a process to provide the vaccines on site or close to each facility as a convenience for physicians who may not be currently vaccinated in accordance with the new policy. “We will have the process in place for physicians next month,” said Bravard, who added that the sheer number of people affected by the policy - including physicians, employees, volunteers, contractors, medical students and many others - makes it a massive undertaking for the System in general and the Memorial Hermann-TMC Campus in particular.

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New STAT Lab Opens in HVIA new STAT lab is opening this month in the Memorial Hermann Heart & Vascular Institute-Texas Medical Center (HVI), in an effort to better meet the emergent laboratory diagnostic needs of their most critical patients. The new lab, located on the 7th floor in what was formerly an OR clean equipment storage area, provides two basic areas of service – STAT lab tests and provision of blood from the Blood Bank. “The genesis of this project was prompted by the establishment of the congestive heart failure group and the types of surgeries they perform, such as implanting left ventricular assist devices,” said Cheryl Chanaud, Ph.D., executive director of the Clinical Innovation and Research Institute for the Memorial Hermann Healthcare System, who has been helping to oversee the opening of the new lab. “Once that decision was made, it was our hope to serve the STAT lab needs of the HVI in total, and fortunately we were able to do that.” The new STAT lab has its own pneumatic tube system which is designed to facilitate a speedier transport for tubes traveling only within the HVI than those that go from the HVI to the main lab. Normal lab requests that are not emergent will continue to be facilitated through the Campus’ main lab. “It’s very similar in concept to the STAT lab in the ED, with a few extra additions such as blood coagulation testing,” said Chanaud. Chanaud and the laboratory services team worked with physician leadership, nursing and ISD on the interface and menu to make sure that the new STAT lab ordering process is more definable for the caregiver team. “We want to ensure a smooth and reliable process that the physicians and nurses are both knowledgeable about and comfortable with,” said Karen James, director of Laboratory Services for Memorial Hermann-Texas Medical Center. “We made sure to involve nursing throughout all of our planning to make sure everything easily matches up in Care4.” Most of the STAT lab requests, and even single units of blood products, can be sent through the pneumatic tube with a few exceptions, noted James. “Any

thromboelastography (TEG), Plavix effect or platelet effect tests must be hand delivered. Because the STAT lab is in the HVI OR, which is of course a sterile environment, for now you must gown up when you deliver specimens or pick up coolers of blood products. We are hoping to create a process for pick-ups and drop-offs where staff doesn’t need to enter the sterile environment.” James also added that the new labwill not be able to provide STAT “manual differentials” when a complete blood count (CBC) is ordered; those will follow from the main lab. In addition, troponin T analysis will be done in the main lab only and the STAT lab will perform troponin I analysis. Overall, the project took less than six months to complete, from inception to opening. Chanaud credits the dedication and support of Paul O’Sullivan, chief executive officer of the HVI and Sandra Ratliff, System laboratory executive, for working so diligently with facilities engineering and the administrative team to enable such quick progress. “The new HVI STAT lab is about providing the highest quality care for our patients,” said Chanaud. “We are focused on

improving turnaround times for HVI lab results, which keeps the nurses at the bedside and ultimately creates a better environment for our physicians to practice medicine.”

In addition to providing blood products to all HVI patients, the HVI

STAT lab will provide tests for common STAT lab orders, such

as these listed below:

• Cardiac enzymes • Chemistry tests • Coagulation tests • Hematology tests • Lab panels • Pregnancy tests • Urinalysis

For a detailed STAT lab order menu, please visit the TMC Connections

page of InSite.

Pictured from left to right are Loretta Chow, operational lab manager, Karen James, director of Laboratory Services for Memorial Hermann-TMC and Rhonda Hobbs, Blood Bank manager. With assistance from James,

the two co-managers of the new HVI STAT lab will oversee its daily operations and three dedicated employees.

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Outbreaks Call for Increased Focus on Hand Hygiene ComplianceA significant rise in outbreaks of Clostridium difficile infection (C. difficile) and bloodstream infection (BSI) across the Campus have prompted a renewed focus on hand hygiene compliance. According to the Centers for Disease Control and Prevention (CDC), poor hand-hygiene practices by physicians and other members of the healthcare team are one of the biggest culprits in such outbreaks, and if CDC guidelines were followed correctly, diarrheal disease-associated deaths could be reduced by up to 50 percent and up to 1 million lives could be saved each year. “There is no doubt that non-compliance with hand-hygiene practices as outlined by the CDC results in outbreaks, and we can do better,” said Jeffrey Katz, M.D., chief medical officer for the Memorial Hermann-Texas Medical Center Campus. “I am asking for everyone to do their part as we work to change the culture around proper hand hygiene.” While the Memorial Hermann-TMC Campus has a hand hygiene program that has been in effect for several years, gaps in the collection and reporting of data as outlined in the program have occurred across many different units and departments. These same areas are the ones experiencing the worst outbreaks. As a result, the program has recently been updated by the Performance Improvement Review Committee (PIRC) to help improve compliance.

“It really takes a village to change the culture around hand hygiene,” said Jo-Ann Kamencik, Ph.D., regional clinical effectiveness director for the Campus. “PIRC is very focused on ensuring we do everything possible to increase compliance and reduce the incidence of these preventable infections.” Clinical managers on each unit are the assigned Hand Hygiene Program process owners. They are responsible for managing the initiative for all designated areas by identifying and training secret observers and “just-in-time” coaches, designating a data entry person, communicating compliance and fallouts with staff, and rewarding good compliance. Every unit must have a minimum of 40 observations every month, which must be entered by the 7th of the month so that the results can be included in the Monthly Operating Report to System executives. The updated program now requires any unit

not in compliance to present an action plan to PIRC. In addition, PIRC has suggested incorporating hand-hygiene compliance to employee performance evaluations beginning this year, a proposal that is now under review by the executive team. Another recommendation is to require all healthcare workers to sign a “commitment to perform hand hygiene” during annual evaluation with their manager or director, and physicians, residents and medical students to sign the same form at the time of on-boarding, credentialing and re-credentialing. “The process we have in place is extremely effective when everyone is vigilant,” said Dr. Katz. “Proper hand hygiene is probably the most singularly effective practice our physicians can do on a regular basis to save lives.”

CDC guidelines call for healthcare providers to “practice

hand hygiene at key points in time to disrupt the transmission of microorganisms to patients including: before patient

contact; after contact with blood, body fluids, or contaminated

surfaces (even if gloves are worn); before invasive procedures; and after removing gloves (wearing gloves is not enough to prevent

the transmission of pathogens in healthcare settings).”

“Proper hand hygiene is very important to

decrease the spread of all infections, but particularly

for the new strain of C. difficile, which has been associated with more severe disease and

increased mortality,” said Luis Ostrosky, M.D.,

director of epidemiology at Memorial

Hermann-TMC and professor of infectious

disease at The University of Texas Health Science

Center at Houston (UTHealth) Medical School.

“This infection is unique, and other than anthrax,

is the only other infection that requires healthcare professionals to wash thoroughly with hot

water and soap, as the alcohol hand-sanitizing gel doesn’t effectively kill the

spores.”

Medical Executive Committee: September Meeting Briefs for the Medical Staff

• Victoria King, the new chief nursing officer for Memorial Hermann-TMC, was introduced to the committee.

• The Robotics Credentials Subcommittee presented revised reappointment criteria for robotic privileges. The criteria was approved and sent for review to the Division of Quality and System Quality Committees.

• Richard Blakely, M.D., presented on the Memorial Hermann Physician Network (MHMD) CPCs structure, function, role and relationship to the medical staff. He reviewed the history of the Memorial Hermann Healthcare System and its evolution into the multi-faceted institution of today. He also reviewed the evolution of the CPC, beginning in 2000 with the System P&T Committee. Dr. Blakely noted there are specialty-specific

The Medical Executive Committee (MEC), comprised of physicians and members of the Memorial Hermann-Texas Medical Center Campus administrative team, meets on the first Friday of each month to make important decisions impacting patient care and the practice of medicine on our Campus. All medical staff committees report to the MEC. The voting membership, all elected by the medical staff, consists solely of physicians and includes a president,

president-elect, six physicians from The University of Texas Health Science Center at Houston (UTHealth) Medical School and six physicians in private practice. Ex-officio members include the hospital administrative team, as well as the past-president. To keep you informed about the most up-to-date issues impacting the medical staff across our Campus, here are highlights from the September MEC meeting:

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Recent Medical Staff Appointments

• KellyLynneBirt,M.D. General Surgery

• AndrewMoonChoo,M.D. Orthopedic Surgery

• GuenetH.Degaffe,M.D. Pediatric Infectious Diseases

• RandallC.Edgell,M.D. Neurology

• MeshaanS.Fitzgerald,M.D. Pulmonary Medicine/Critical Care

• SemharJ.Ghebremichael,M.D. Anesthesiology

• DanaMichelleGrellhesl,M.D. Anesthesiology

• MirzaQasimHasan,M.D. General Internal Medicine/Hospitalist

• TakijahTiffanyHeard,M.D. Pediatrics

• JessicaAnnHudson,M.D. Emergency Medicine

• JenniferHsu-JenJohnston,M.D. Pediatric Radiology

• KellyLynnLarkin,M.D. Ophthalmology

• DavidL.Lin,M.D. Orthopedic Surgery

• ElaineM.Magat,M.D. Physical Medicine and Rehabilitation

• RachelLynnMetz,M.D. Emergency Medicine

• JoanneVillaNguyen,M.D. Pediatrics

• KimYenThiNguyen,M.D. General Internal Medicine/Hospitalist

• BobbyRayNix,M.D. Psychiatry

• DianaGwynethRickard,M.D. Pediatrics

• AmyElizabethRiedel,D.P.M. Podiatry

• RabihSaid,M.D. Oncology

• AntolinTrainidad,M.D. Psychiatry

• VirginiaTowlesWeathers,M.D. Obstetrics and Gynecology

• JasonLindseyWolf,M.D. Radiology

• RodrickChitaurirwaZvavanjanja,M.D. Radiology

subcommittees with two physicians from each Memorial Hermann medical staff on the subcommittee. Representatives from Memorial Hermann administration, nursing, care management and pharmacy are included on each subcommittee. The value propositions of CPCs were reviewed. The report was approved as submitted.

For questions regarding the MEC and issues coveredduring the monthly meeting, please contact Dr. Katz at713.704.3500.

Memorial Hermann Healthcare System

Affiliated with The University of Texas Health ScienceCenter at Houston (UTHealth) Medical School

7737 Southwest FreewayHouston, TX 77074

Medical Staff News - Editorial Staff

Jeffrey Katz, M.D.Chief Medical Officer

Alejandra RodriguezDirector, Communications and Volunteer Services

Medical Staff News is a publication of Memorial Hermann-TMC Internal Communications. We welcome your comments and suggestions.

713.704.1222

medicalcentercommunications@ memorialhermann.org.

Upcoming Medical Staff EventAll members of the medical staff are invited to attend the next quarterly meeting

featuring a special presentation by Michael Shabot, M.D., System Chief Medical Officer.

The Future of Quality Measures and Value Based Purchasing for Physicians and Hospitals.

Tuesday, October 30Hermann Conference Center

5:30 p.m. Dinner Buffett6 p.m. Presentation

To RSVP please contact Casandra Austin at 713.704.4294 or casandra.austin3@memorialhermann.org

Learning Objectives—Upon completion of this activity, participants should be able to: 1) Follow evidence based guidelines for safe and efficient patient care; 2) Ensure that the date and results reported for the hospital and practice are accurate; 3) Ensure the

above by specific information related to documentation.

This activity is relevant to all practicing TMC Medical Staff—UT and Private physicians, Adult and Children’s Hospitals

Memorial Hermann Hospital System is accredited by the Texas Medical Association to provide continuing medical education for physicians.

Memorial Hermann Hospital System designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™.

Physicians should only claim credit commensurate with the extent of their participation in the activity.

This course has been designated by Memorial Hermann Hospital System for 1 credit of education in medical ethics and/or professional responsibility.

The Rapid Response Team can be called by anyone – the patient,

family members, visitors and staff – for any patient who seems

to be in distress, getting sicker and when a physician is unavailable.

Warning signs that would prompt a Rapid Response call include:

•Changesinheartor respiratory rate

•Adropinbloodpressure •Changesinurinaryoutput •Confusionorothermental status changes

The Rapid Response Team may be contacted at 713.704.4444.

Rapid Response