Liver in a Can
Evidence-Based Guidelines on the Web
Healthy Habitats
Now There Are Three
Hope for Brain Tumor Patients
Emory Ranks High
Cancer Initiative
No-Wait Check In
Grade "A" for Management
Emory Peachtree Seeks New Home
Yea or Nay: New Laws Affect Health Sciences

Moving Forward

Emory physicians are trying to fill a critical lack of donor organs by using an extracorporeal liver assist device (ELAD) that keeps patients alive until donor organs become available.

ELAD was a lifesaver for a 31-year-old Marietta man -- the first patient in the Southeast and the eighth in the nation to be connected to the new device now in Phase I clinical trials at Emory. Marc Mitchell was admitted to Emory Hospital in April after suffering from flu-like symptoms which unexplainedly developed into liver failure. "They told me that without that machine I had only a 1 in 1,000 chance of surviving," he remembers. He was on ELAD for 26 hours before receiving a liver transplant.

This artificial liver works much like a kidney dialysis machine. It pumps the patient's plasma, which it separates from the blood, through an external canister. In it, millions of human liver cells perform all the functions of the real organ, including filtering the blood and producing clotting factors.

"By using these liver cells, we can keep someone in liver failure in viable condition until he or she can get a donor liver," says transplant surgeon Thomas Heffron. With ELAD, the patient's brain and organs can be protected for up to 10 days, giving time for the liver to recover or for the patient to find a donor organ.

Time is what most patients with organ failure need. Last year, more than 4,000 people died while waiting for donor organs. That number is expected to rise as more people need organs while the number of donors remains static. In two years, 40,000 people may need livers, says Heffron, but only 6,000 will be available. ELAD may help balance the ledger.

Liver in a Can

Emory Healthcare is teaming with four other academic centers to launch a web-based e-healthcare venture that will provide evidence-based clinical guidelines for treating more than 400 medical conditions.

The start-up company, known as WebEBM (the last three letters stand for evidence-based medicine), is assembling guidelines written by faculty from Emory, Duke, Vanderbilt, Washington University (St. Louis), and Oregon. Clinical advisers from Emory are William Bornstein, chief quality officer and associate administrator of Emory Hospitals, and Kimberly Rask, assistant professor of medicine and health policy and management. Over the next three years, they will recruit faculty authors for about 100 guidelines, 40 of which will be launched later this year. Emory faculty and staff will have access to the guidelines for possible use in their practice and by their patients.

Organizations licensing the WebEBM product will make it available to physicians and other health care providers and their patients. Patients referred to the site by their physicians will be able to see the recommended guidelines used by physicians and an easy-to-read and understand patient/consumer version of the same guideline.

"And as the evidence mounts or changes, the Internet platform will allow us to update the guidelines almost immediately," says Rask. A mechanism for patients to provide feedback will allow physicians to compare their patient outcomes with other practices as a way of continually improving care. For more information about WebEBM, see

Evidence-Based Guidelines on the Web

In July, Atlanta Habitat for Humanity turned over the keys to the house that radiology built to new home buyer, Dorothy Crutchfield, and her 17-year-old daughter, Temika. The School of Medicine's department of radiology underwrote $45,000 of construction costs and provided as many as 35 volunteers, including department chair William Casarella, for seven Saturdays this summer. The project began last October, when radiology faculty, residents, and staff passed on their annual Christmas party to donate the initial fund-raising gift through monies raised at a silent auction. Contributions continued to roll in throughout the year through individual donations from a "buy a brick" campaign.
Healthy Habitats

Patients and staff at Wesley Woods Hospital should see more patient flow between hospitals now that the long-time Emory neighbor is integrated into Emory Hospitals. The move, effective June 1, is designed to help the geriatric hospital weather the most challenging economic times it has ever faced.

Sweeping changes in reimbursements have hurt hospitals nationwide but disproportionately hit Wesley Woods Hospital, where most patients are senior citizens on Medicare. After a painful $4.2 million deficit last year, system-wide efforts to enhance how patients flow to Wesley Woods within the Emory Healthcare system, improved patient case management, and aggressive efforts to improve efficiency contributed significantly to reducing the rate of loss in FY2000 by almost $3 million.

Fully integrating Wesley Woods Hospital with Crawford Long and Emory University hospitals will improve efficiency and effectiveness of care in all three hospitals, which are under the direction of Emory Hospitals CEO John Henry. Costs should go down by eliminating duplication and standardizing supplies, policies, and procedures.

Emory wants to do more than create savings from the consolidation, however, says Michael Johns, executive vice president for health affairs. "We want to improve the continuity of care for patients at Wesley Woods and within Emory Healthcare, work better together as a family of institutions, and maximize Wesley Woods' potential."

The mission of Wesley Woods will not change, according to John Fox, president of Emory Healthcare. The hospital will continue to focus on the complex needs of frail elders who have multiple diseases and conditions that are often difficult to diagnose and manage.

Now There Are Three

Emory Hospital is one of only five medical centers in the country using the GliaSite Radiation Therapy System (GliaSite RTS) to control brain cancer. The results are promising.

The first patient to have the procedure is undergoing outpatient rehabilitation for the brain injury caused by the tumor itself. No unusual side effects have been noted in three patients treated to date, says neurosurgeon Jeff Olson, who is working with radiation oncologist Ian Crocker in a safety trial for the new therapy. "One patient, however, has succumbed, a not unexpected event in this difficult group of patients."

The GliaSite RTS places high-dose radiation directly into the tissue likely to contain residual cancer cells following tumor removal. A temporarily implanted balloon-tipped catheter delivers site-specific internal radiation with limited exposure to healthy brain tissue. The internal radiation inhibits tumor regrowth by injuring tumor cells and impairing the cells' ability to reproduce.

"At the time the tumor recurs, treatment options can be limited because of prior radiation and chemotherapy," says Olson. "The GliaSite RTS offers a simplified, alternative method of delivering intense local doses of radiation to recurrent malignant brain tumors." The GliaSite RTS device is implanted when the tumor is removed and is later filled with a liquid radiation source. The catheter is removed within three to seven days. The procedure uses minimal surgical intervention and offers a less disruptive option to the patient and an opportunity to avoid the side effects associated with chemotherapy.

"This device has provided the patient and family an additional period of disease control," says Olson. "But more important, hope."

Hope for Brain Tumor Patients

Components of the Woodruff Health Sciences Center continue to shine. Most recently, Emory University Hospital (EUH) scored high in eight of 17 medical specialties ranked in U.S. News & World Report's best hospitals issue.

EUH's cardiology program, ranked ninth, has been among the top 10 programs in the nation since U.S. News began ranking hospitals in 1990. This year, Emory is the only hospital in Georgia and the Southeast included in the top 10 in cardiology.

Ophthalmology, one of the few specialties ranked entirely on reputation, rose from 10th in 1999 to eighth in 2000. In the magazine's first rankings of hospitals treating kidney disease, EUH came in 13th. Also highly regarded were EUH's programs in urology (18), neurology/neurosurgery (25), geriatrics (31), gynecology (34), and gastroenterology (37).

Most of the programs are ranked with a system that combines reputation among specialists with death rates and other measures that physicians and social science researchers believe reflect quality of care. These rankings also reflect the strengths of Emory Healthcare as a system.

The School of Medicine placed 19th among the nation's medical schools in U.S. News' annual ranking of graduate and professional schools. Emory moved up a notch from last year in student selectivity and reputation by residency directors. The school's physical therapy and physician assistants programs were ranked third and fourth in the nation, respectively.

At the Veterans Administration Medical Center (VAMC), where Emory physicians practice, teach, and conduct major research, the multidepartmental research program ranked 11th among 106 VA medical centers for FY99. The VAMC program includes more than 200 projects conducted by 88 principal investigators.

Emory Ranks High

Vice president and presidential candidate Al Gore pledged to double the national investment in cancer research over the next five years. In his June visit to Emory, Gore called for greater access for cancer patients to prevention and treatment, including full Medicare coverage for cancer screenings. He proposed a national initiative to detect and treat colon cancer early, to encourage paid time off for cancer screenings, and greater access to clinical trials for cancer patients.
Cancer Initiative

Imagine the frustration of making a reservation at a hotel, expecting a bed after a long day on the road, only to be told "sorry, you'll have to wait" because the previous guest hasn't vacated.

A similar scenario often plays out at Emory University Hospital (EUH). Unlike a hotel, at a hospital it's hard to predict how long a patient will need a bed. Patients checking in for scheduled procedures often have to wait for a bed to free up. The result is disgruntled patients and strained EUH staff.

The goal of the new care initiation unit (CIU) at EUH is to alleviate long waits. The brainchild of the admission discharge and transfer task force, the 17-bed unit - with nine beds dedicated to care initiation and eight for overflow patients - can now accept any patient with doctors' orders for routine lab work, x-rays, nutrition, or medication. When a patient checks into the CIU, one of the newly recruited 10-member staff enters him into the admissions database, so ancillary services can begin tests and provide other services before the patient reaches his final destination. That wasn't possible when patients were stuck in an anonymous waiting room. Because the CIU takes over these duties, it not only speeds the admissions process but takes away additional responsibilities from the floor where the patient is finally destined.

"So far, the response has been fantastic," says Jane Vosloh, director of nursing for perioperative services at EUH. "We've exceeded our expectations. Doctors and patients alike say less time is wasted. Patients and their families are more comfortable waiting in a private room with the comforts of television and the attention of a nurse.

"The barometer for admissions backup used to be the coffee and cookie cart that comes out when patients and families have been waiting there a long time," Vosloh notes. "One admissions staffer told me she hadn't seen that cart in a long time."

In fact, patient intake time is down from as long as two to four hours to 51 minutes from admissions to the CIU. The ultimate goal, of course, is to make admissions even faster.

Because the project's success depends on receiving patients with doctors' orders, the unit works closely with physician groups to fast-track patients to the CIU. New clients of the CIU include patients needing renal transplant evaluations, vascular and neurology patients, and direct admits from the ER. As doctors are becoming more familiar with CIU services, the unit has experienced steady growth since opening in February. Vosloh hopes that the renovated Crawford Long Hospital will have room for its own CIU.

No-Wait Check In

At a time when most hospitals in the country are struggling with spiraling drug costs and deep federal budget cuts, Grady Health System has saved more than $44 million on operations since 1997. In a recent report from the senior partner of Deloitte Consulting, one of the nation's top firms, Grady received an "A" for hospital management.

The savings is $12 million more than APM, another top consulting firm, thought possible just three years ago when it gave Grady a B+ rating. Grady today leads the nation in most benchmark measures for large public hospitals and locally ranks in the top quartile for cost-effectiveness and labor productivity.

Emory's 85-year affiliation with Grady is key to many of the university's teaching and research programs. Emory faculty, residents, and medical students are responsible for providing most medical care at Grady. (See "The Grady Crunch," Winter 2000 Momentum.)

Grade 'A' for Management

In the first major joint venture of Emory and HCA (formerly known as Columbia/HCA) since they allied a year ago, Emory Peachtree Regional Hospital is seeking state approval to build a new $65-million facility in Newnan. Emory and HCA would share the cost of the facility, which would replace the current hospital.

The new 118-bed hospital, located about 3.5 miles from the current facility in fast-growing Coweta County, would be more convenient for outpatients in particular, says Emory Peachtree CEO Linda Jubinsky.

Currently, more than 40% of Coweta County residents go to hospitals out of the county for care. Emory Peachtree provides the area's only obstetrical labor and delivery services, 24-hour emergency services, workplace health programs, and outpatient testing, diagnostics, and surgery.

When the current 143-bed facility opened nearly 40 years ago, inpatient stays were the norm. Today, advances in technology and medicine offer more patients convenient outpatient services, which the hospital plans to offer in a patient-friendly setting. Renovating the existing facility would cost almost as much as building a new hospital.

With state approval, groundbreaking for the new facility is planned for late this year, with an opening date targeted for spring 2002. It will be located on a 24-acre site, one mile west of I-85, on Bullsboro Road.

Emory Peachtree Seeks New Home

A number of new Georgia laws effective July 1 are expected to have immediate health care implications for Emory.

Perhaps the most important is House Bill 1300, says Betty Willis, associate vice president, government and community affairs. It responds to the pharmaceutical industry's concern that a 1999 law protecting confidential raw research data from litigation would actually prohibit research. HB1300 stipulates that the earlier law applied to research affected by litigation only and not day-to-day operations of clinical trials. (See "Getting into the act...and the act into law," Winter 2000 Momentum).

A number of other new measures became law this summer:

Funding teaching hospitals

Historically, residents at teaching hospitals such as Grady have been funded through the state Board of Regents. However, proponents for House Bill 1411 contended that teaching medicine is unlike other education since health care has far-reaching implications that could be better addressed by the new Department of Community Health (DCH). The General Assembly agreed.

While the DCH recommended a funding increase for medical residents from $2,300 to $4000, legislators approved the governor's recommendation of just $253 more per resident. Funding compensates Grady directly for Emory residents at the hospital.

Yea or Nay: New Laws Affect Health Sciences

Child protective custody

Georgia physicians may take or retain temporary custody of a child they are treating if the physician believes the child's life or health is in danger as a result of suspected abuse or neglect. Such action may be taken without a court order if the need is immediate. Both physicians and hospitals are granted immunity from liability for taking such actions.

Study groups

New laws also created study committees to address family violence, prevention of and emergency care for injuries, indigent care funding, and the long-term care industry.

GMC Authority

Emory will closely monitor the long-term effects of Senate Bill 440, which created the Georgia Medical Center Authority. It will coordinate biomedical and biotech research center facilities and programs based in Augusta and promote closer ties between the academic institutions of Georgia and the biomedical industry. Many questions remain about the authority's impact on Emory and Georgia Tech's joint biomedical enterprises.

Tobacco money

The issue of where money from tobacco settlements will be directed continues to simmer as the General Assembly directed a third of Georgia's share to promote rural economic development, including health care. In addition, a state budget measure set aside $15.7 million to be administered by the Department of Human Resources (DHR) for tobacco cessation and prevention programs.

With some of those funds, DHR's division of public health is implementing programs in these areas:

  • Chronic disease prevention to reduce heart disease, stroke, diabetes, cancer, and tobacco use
  • Expanded cancer screening and follow-up
  • Testing the hearing of all infants, regardless of the ability to pay
  • AIDS drug assistance
  • HIV-waiver drug therapy

Research funding

Taxpayers can support breast, prostate, and ovarian cancer research by checking a box on their income tax returns in the future. DHR will decide how the money (not to exceed $50,000 a year) is spent.

More on residents' salaries

While both the School of Medicine's preventive medicine residency program and the Rollins School of Public Health's occupational and environmental residency program train physicians to do "population-based" work, their residents in the past have not received direct support from the state. Many have had to moonlight to make ends meet. The 2000 state budget included $60,000 to help pay for these residents' salaries.

Execution by lethal injection

All offenders sentenced to death after July 1, 2000, will be executed by lethal injection rather than the electric chair. Under the new law, physicians will not be required to give the lethal injections.

Medical scholarships

DCH now can help direct clinical talent where it's needed in rural areas. The department has been granted oversight of medical scholarships for students who agree to work in rural communities.

Georgia Research Alliance

The GRA's budget passed unscathed this year for a total of about $34 million to promote biotech R&D. Emory stands to gain from this banner year for the GRA, with a $3.9 million boost for a number of Emory initiatives.

The Center for Neurosciences will receive about a third of Emory's share. GRA funds also will fund the first installment of a high-field MRI at Emory Hospital, a specialty caging system at Yerkes, and AIDS and gene research at Emory. A portion will also be used to equip the eminent scholar program as well as the technology development center at EmTech (Emory West).

Uniform health insurance card

Emory has long advocated for this new requirement for insurance companies to provide subscribers with an identification card that contains certain information, such as prescription drug coverage.

Poison Control Center

Emory physicians have a contract to provide all poison control in Georgia. But despite increasing services, that program has not received a funding boost since the early 1990s. Emory led the successful effort to increase funding to $314,000 annually.

Cancer State Aid

The state proposed cuts of more than $424,527 to the Cancer State Aid program, which provides cancer treatment for the working poor. Those cuts would have impacted Grady, Crawford Long Hospital, and Emory, all of which would not have been reimbursed for already completed treatments. The proposed cut was restored.

Cuts restored for nursing

The state also proposed to cut the nurse loan repayment program, which provides $2,000 scholarships for nursing students who, in exchange, must work in Georgia for one year. That was particularly worrisome since the new $30 million school nurse program will require a nurse in every school in the state but includes no funding for training those nurses.

Emory helped get the scholarship funding restored during the General Assembly and hopes eventually to get involved in the training of those nurses. Emory's Nell Hodgson Woodruff School of Nursing will present a forum at the end of September to state and local officials regarding school health and school health nursing.

Medicaid increases

  • Increased Medicaid inpatient hospital rates to adjust for inflation
  • Increased emergency room rates for Medicaid nonemergencies from $25 to $50
  • Increased Medicaid reimbursement to physicians, a move particularly welcomed by Crawford Long and Grady hospitals
  • Expanded Medicaid eligibility for pregnant women and infants to families with incomes from 200% to 235% (about $30,000) over the federal poverty level
  • Expanded eligibility for PeachCare, which insures children of families with incomes under the poverty level, to about 235% of the poverty level.

Unlocked waiting lists

More patients will be able to leave institutions and get care at home, thanks to additional funding for the elderly, the mentally retarded, and people with disabilities and brain injuries.

In this Issue

From the Director  /  Letters

Imitation of Nature

A Cut, a Shave, and a
Blood Pressure Check

Medical Mistakes:
Human Error or System Failure?

Moving Forward  /  Noteworthy

Putting on the Ritz, Part Two

What didn't happen

Some measures that didn't pass the 2000 Georgia General Assembly may have been as significant as those that did, says Willis.

One such failed bill would have created a committee of state legislators to oversee Grady Hospital and its board.

And Emory opposed an unsuccessful measure seeking to grant optometrists prescriptive authority. On the other hand, the university favored a compromise between the Medical Association of Georgia and the state nurses association in regard to the house version of SB 560, authorizing nurses to prescribe medications in a collaborative practice agreement with physicians. That bill with amendments stalled in a Senate committee, where it never came up for a vote.

To learn more about the 2000 Georgia General Assembly, visit this web site:


Copyright © Emory University, 2000. All Rights Reserved.
Send comments to the Editors.
Web version by Jaime Henriquez.