May 21, 2018 | Featured, Research
Joanna Chikwe, MD
At the first plenary session of the 98th Annual Meeting of the American Association for Thoracic Surgery in San Diego, Mount Sinai’s Joanna Chikwe, MD, Professor of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, and David H. Adams, MD, presented a research study examining outcomes of patients undergoing coronary artery bypass grafting (CABG) surgery in the state of New Jersey, comparing results in patients treated on an arrested heart while on a heart-lung machine (on-pump) versus those approached on the beating heart (off-pump).
Dr. Chikwe, who is also the Cheng Endowed Professor and Chief of Cardiothoracic Surgery and Director of the Cardiovascular Institute at the State University of New York, Stony Brook, provided data aimed at resolving a four-decade-old debate regarding the optimal approach to perform CABG surgery.
The researchers compared outcomes 10 years after on-pump and off-pump surgery performed by high-volume surgeons in more than 20,000 patients.
“Our preliminary results found that outcomes with on-pump surgery were superior, with lower mortality, lower under-revascularization, and lower need for repeat revascularization after on-pump bypass surgery,” says Dr. Chikwe. Their paper has been provisionally accepted for publication in the Journal of the American College of Cardiology.
In March, Dr. Adams and Dr. Chikwe wrote an editorial in the Journal of the American College of Cardiology about the same topic, saying, “It is time for the debate to move on.”
May 21, 2018 | Community, Featured
Nursing assistants, trained as observers, monitor patients from a secure location.
A new Remote Patient Monitoring Program system, introduced in five units at The Mount Sinai Hospital as a pilot project in 2015, has expanded throughout the hospital and to Mount Sinai Queens, a unique technological effort to help nursing staff reduce falls among high-risk patients and keep them safe.
From left, Francine Fakih, MA, BSN, RN, with Michele Isaacs and Mario Geritano by the Remote Patient Monitoring device.
“Our entire nursing staff is trained in helping patients and caregivers learn safety measures to prevent falls, but some hospital patients who may try to get out of bed unsupervised remain prone to falling when they are weak, confused, or medicated,” says Francine Fakih, MA, BSN, RN, Deputy Chief Nursing Officer, The Mount Sinai Hospital, who oversees the program. “This new tool complements our existing patient-safety programs.” The Remote Patient Monitoring Program is being used in 19 units at The Mount Sinai Hospital and 6 units at Mount Sinai Queens.
The visual monitoring and two-way audio system consists of a camera and speaker that are mounted on a portable cart that is placed in the hospital room. The camera beams real-time video to computer screens that are monitored by trained nursing assistants observing from a secure hospital office. “This technology enhances the ability of our nursing unit teams to use all of their personnel more effectively, while safeguarding our most vulnerable patients,” says David L. Reich, MD, President of The Mount Sinai Hospital and Mount Sinai Queens.
“When a patient is trying to get out of bed, the observer will use the speaker to redirect the individual,” explains Michele Isaacs, Program Coordinator, Surgical/Medical Specialties. Once the audio is activated, the patient and observer can continue talking. The observer can better determine the patient’s need and alert the nursing station to respond. In a real emergency, the observer can set off an alarm that summons immediate help. Staff can also redirect patients they observe trying to pull out their IVs.
The system—which meets all privacy policies and does not require the consent of the patient—does not record video and audio, and allows the observer to listen in only when the monitor is activated. It also has privacy settings, giving staff in the hospital room the ability to turn off the video and audio monitor during a physician visit and other private moments.
Says Mario Geritano, Project Manager, Program Management Office, Information Technology, Mount Sinai Health System, “We are using technology to provide additional support for our clinical team while allowing for a continuous, safe monitoring experience for our patients and families.”
May 21, 2018 | Featured, MSBI, Your Health
Maria Brito, MD, Director of the Mount Sinai Thyroid Center at Union Square, and Terry F. Davies, MD, Co-Director.
The Mount Sinai Thyroid Center at Union Square is a valuable new resource for patients with thyroid disorders, as well as physicians seeking referrals for complex cases. The Center is unique in gathering a wide array of services in one ambulatory facility.
“This collaborative center includes Endocrinology, Endocrine Surgery, Head and Neck Surgery, Pathology, and Radiology,” says Director Maria Brito, MD, Assistant Professor of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine at Mount Sinai. “I don’t think there is another thyroid center in Manhattan that has all of these services in one single building.” The Center is still expanding and will be joined by a Diabetes and Endocrine Center at Mount Sinai Union Square within the next year.
One goal of the Thyroid Center is to simplify care. “It is one-stop shopping, which is what we all want when we go to the doctor,” says the Center’s Co-Director, Terry F. Davies, MD, the Florence and Theodore Baumritter Professor of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine at Mount Sinai. “If your physician says you need to see another specialist, it’s nice if he or she is in the next room. Y
ou can have your interview with the specialist and the surgeon; you can have a biopsy; you can have a sonogram; and you can have your blood tests, all in the same visit.”
New patients will be offered an appointment within 72 hours, Dr. Davies says, addressing a frequent complaint in medical care— having to wait weeks for an appointment.
Five endocrinologists and five surgeons are active in the Center, including leaders in their fields, Dr. Davies says, such as William B. Inabnet III, MD, Chair of Surgery, Mount Sinai Beth Israel, and Professor of Surgery at the Icahn School of Medicine; and Mark L. Urken, MD, Professor of Otolaryngology at the Icahn School of Medicine. For appropriate patients, “remote access” thyroidectomy can be offered, in which the thyroid is removed through incisions in the armpit or the mouth, leaving no visible scar on the neck. For certain patients with recurrent cysts, nodules, and some thyroid cancer recurrences, Dr. Brito and her colleague Michael A. Via, MD, Assistant Professor of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine, offer a minimally invasive option, ethanol ablation, in which an alcohol solution is injected into these lesions, causing reabsorption or destruction.
Additionally, the Center is the national headquarters of the Thyroid, Head & Neck Cancer (THANC) Foundation, founded by Dr. Urken. The nation’s largest private funder of research for these cancers, THANC administers the Thyroid Cancer Care Collaborative, a data registry in which physicians can record important data about their thyroid cancer patients, enabling them to share clinical information with their patients as well as de-identified data with other physicians and researchers.
The Center’s physicians work closely with peers across the Mount Sinai Health System. For example, “we meet twice a month for the thyroid tumor board, in which surgeons and physicians discuss difficult cases,” says Dr. Davies, a leading physician-scientist in autoimmune thyroid disease who has been funded continuously for 35 years by the National Institutes of Health. Sharing knowledge among peers is a top priority of the Center, which is an important referral destination for primary care doctors seeking to consult with endocrinologists, and for endocrinologists seeking to collaborate with surgeons.
“We think this is definitely an appropriate place for second, third, or fourth opinions,” Dr. Brito says. “But it is very important for both primary care doctors and specialists to know that we expect to collaborate with them. They will not lose their patient to the Center, instead, they will gain a colleague.”
May 8, 2018 | Featured, Your Health
Mount Sinai at Home leaders, from left, Operations Director Alexander Mandl; Albert L. Siu, MD; and Clinical Director Linda V. DeCherrie, MD, Professor of Geriatrics and Palliative Medicine.
The Mount Sinai Health System recently launched Mount Sinai at Home, an innovative enterprise with two key components: a service line of programs across the Health System that care for patients in their own homes, and a research arm, the Institute for Care Innovations at Home.
“Mount Sinai at Home’s programs will align closely with the Health System’s population health strategies and advance our capacity to serve communities beyond our hospitals,” says Director Albert L. Siu, MD, Professor and Chair Emeritus of Geriatrics and Palliative Medicine. Treating patients in familiar and convenient environments can improve communication, coordination, and continuity of care, and reduce the risk of admission and readmission.
“This all started with Mount Sinai Visiting Doctors, which was founded in 1995 and gave us an opportunity to create the Mobile Acute Care Team (MACT),” Dr. Siu says. “When MACT started out in 2014, it was just Hospitalization at Home, but very quickly our teams found more ways to support our patients and our Health System, so we created services such as Rehabilitation at Home for care after hospitalization.” MACT, which was founded with a $9.6 million Health Care Innovation Award from the federal Centers for Medicare and Medicaid Services, has been a success, treating 750 patients so far. Its name presented a challenge, Dr. Siu says, since “MACT was not particularly descriptive from the point of view of patients.” As all of its home-based programs grew, the Health System saw a need to coordinate them and to find a new, unified name.
The result is Mount Sinai at Home, which is also headed by Clinical Director Linda V. DeCherrie, MD, Professor of Geriatrics and Palliative Medicine, who was Director of Mount Sinai Visiting Doctors and Clinical Director of MACT; and Operations Director Alexander Mandl. Mount Sinai at Home will provide “operational, financial, legal, logistical, and clinical” support for home-based care across the Health System, Mr. Mandl says. Its clinical programs are:
- Mount Sinai Visiting Doctors, providing primary care for homebound patients, who are usually very frail and elderly;
- Pediatric Visiting Doctors and Complex Care Program, for young patients, such as children with chronic illnesses or infants who have just left neonatal intensive care;
- Hospitalization at Home, for patients with a condition that might otherwise call for hospitalization, such as acute pneumonia; and
- Rehabilitation at Home, for patients who need care that might otherwise be provided at an inpatient rehabilitation center.
In March 2017, Frederick Ballen became the 500th patient of the Mobile Acute Care Team—now part of Mount Sinai at Home. He was treated at his home in Manhattan by Caitlin Pelan, RN, left, and Joanna Jimenez-Mejia, NP.
These programs will continue to function in collaboration with the Departments of Medicine, Geriatrics and Palliative Medicine, and Pediatrics. Over time, other efforts and collaborations may be added, such as a palliative care program that is now part of a clinical trial led by R. Sean Morrison, MD, the Ellen and Howard C. Katz Chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine. In the program, a team of nurses, community health workers, social workers, nurse practitioners, and physicians provide care and support to seriously ill patients at home. “If it is successful, we hope to keep this as a clinical program,” Dr. DeCherrie says. Another study led by Dr. Morrison, on the cost-effectiveness of palliative care, was recently published in the Journal of the American Medical Association Internal Medicine.
Mount Sinai at Home also created a payment model for Hospitalization at Home that in September became the first to be approved by Medicare’s Physician-Focused Payment Model Technical Advisory Committee. “When it is implemented, it will be a model that hospitals around the country can use,” Dr. DeCherrie says.
The Mount Sinai Health System has long been a leader in palliative care, geriatrics, and health care at home. “We already have the largest academic house-call program in the country—Visiting Doctors—and our Hospitalization at Home program is already the largest in the country,” Dr. DeCherrie says. “To put it all together under one service line, that is very different and very new.”
“At Mount Sinai Heart’s Cardiac Catheterization Laboratory, our patients’ safety is our No. 1 concern,” says leading interventional cardiologist 