TMH-MedStaff on Lifespan News

Medical Staff Updates

Richard Gold MD — Wed, 17 Mar 2010 19:16:04 +0000

Tim Babineau, MD has been providing updates on the merger and clinical service review process. I would like to add that the subgroups have been working very diligently and cooperatively and the recommendations should be available in the spring. The bylaws revision project is still going forward, although at a slower pace than expected. These bylaws will focus on revision of staff categories, credentialing process, as well as due process. These bylaws will eventually be brought forward for approval at a TMH medical staff meeting. Finally, Peter Karczmar, MD, vice president, and I have been meeting on a regular basis with our counterparts at RIH, Dan Levine, MD and Ed Marcaccio, MD, as well as the chief medical officers Bill Corwin, MD and John Murphy, MD, Juan Bellido of Lifespan legal department and Lois Booth to address the future structure of the combined MEC as well as other issues that have arisen. These discussions have been very congenial and informative.

Other topics

Mark Your Calendar

Third Annual Lifespan Patient Safety Symposium will be held on Thursday, April 8, 2010 at the Crowne Plaza Hotel in Warwick, Rhode Island. The topic is “Patient Safety and the Quality of Health Care in Our Past, Present and Future.” There is no fee to attend. Registration is required and seating is limited. To register for the symposium, please contact the Lifespan Health Connection at 401-444-4800, 1-800-927-1230 or go to www.lifespan.org/about/events/safety. For more information click here.

This has been an outstanding event in the past with over 500 people attending last year’s session.

Lifespan Email

Both the RIH and TMH MEC’s have approved the principle that all medical staff members must maintain an active Lifespan email to facilitate communication with the medical staff. You will be able to forward your Lifespan email to a separate email account as well as filter many of the emails. There will be a notice from the medical staff office in the next several weeks regarding this. The staff will have time to activate their accounts. Notifications and instructions will go out shortly.

Future Medical Staff Quarterly/Annual Meeting Dates

The next quarterly meeting will be Monday, April 12 at 7 a.m. in the Sopkin Auditorium and the annual meeting will be in June on a date TBD.

The Sleep Disorders Center

Arthur Sampson — Mon, 15 Mar 2010 15:52:30 +0000

The Sleep Disorders Center will close its location at The Miriam Hospital effective May 5, 2010, due to lack of volume and inadequate space, which limited our ability to provide the best environment for patients. Sleep medicine services for adults will be available at the ten-bed sleep lab located at 70 Catamore Boulevard in East Providence and the four-bed sleep lab at Newport Hospital.

For information about the services offered, call the Sleep Disorders Center at 401-431-5420.

Merger Update

Timothy Babineau MD — Tue, 09 Mar 2010 13:24:17 +0000

I am writing to provide a few updates on The Miriam Hospital and Rhode Island Hospital merger process. A tremendous amount of work has taken place over the past several months and a tremendous amount of work lies ahead. Our goal remains the same—creating one academic medical center on two campuses that leverages the best each hospital has to offer. I remain more convinced than ever that the increasingly competitive and volatile health care environment requires us to strategically focus on our market through a single unified lens—while maintaining the rich legacies of both institutions. The recent decision to withdraw the Care New England merger application makes, in my mind, the RIH/TMH merger exponentially more important to the future of both institutions.

Much has already been achieved in a relatively short period of time. We have melded our management teams and the trustees of our institutions are meeting jointly to build a shared perspective on a mutually agreed upon direction for our hospitals. Our physician leaders have been working diligently to explore ways of increasing the collaboration and cooperation among the two medical staffs. In addition, the joint clinical services review process is moving along very well and I anticipate receiving those recommendations in the next several weeks. Recall that I asked those groups to focus on three major services lines: open heart surgery, complex cancer care and complex orthopaedic care. While the groups are examining these service lines separately, the recommendations must ultimately fit together like pieces in a jigsaw puzzle to best serve our hospitals and our community. I am hopeful that by late spring I will have a set of recommendations to share with our boards, our physicians and our staff.

In nursing, we have requested and now received a response from The American Nurses Credentialing Center (ANCC) clarifying the impact that the merger may have on the Miriam Hospital’s Magnet designation. In effect, Rhode Island Hospital would need to attain Magnet designation in order for The Miriam Hospital to retain this designation in a merged entity. Magnet designation at The Miriam Hospital is a point of great pride and distinction for us—and deservedly so. As we stated at the outset, we will not allow the Magnet status of TMH to be jeopardized during this process and we are already preparing to submit TMH’s application (due in May) to renew this designation. However, with this recent clarification from the ANCC, we will be intensifying our efforts to achieve Magnet status at Rhode Island Hospital. We will also be utilizing the experiences at The Miriam and at Newport Hospital (also a Magnet designated hospital) to help inform and guide Rhode Island Hospital through this process.

All of these developments are important, and we will work to keep you informed as these and others arise during this process. We are fortunate to have two great institutions that, by coming together in new and exciting ways, create almost limitless potential. Finally, our hospitals’ greatest strengths lie not in bricks and mortar but rather in the strength of our physicians, nurses and employees that come to work here every day. I know that I can continue to count on your optimism, your professionalism, your commitment and your hard work as we boldly confront the future and its challenges. I remain committed to the concept that “The best way to plan for the future is to help create it.”

Patient Safety Award

Timothy Babineau MD — Fri, 05 Mar 2010 17:21:59 +0000

Patient safety is a priority at The Miriam Hospital. While we pride ourselves on our commitment to safety, we recognize that improvements can always be made, and on November 20, we took steps to make those improvements.

November 20 was surgical education day. Only emergency surgeries were performed at both The Miriam and Rhode Island Hospital so that as many staff members as possible could participate. The education sessions, led by nurses and physicians, were attended by surgeons, surgical technologists, physician’s assistants, RNs, RNFAs, anesthesia providers, perioperative assistants and nursing assistants, as well as other surgical support staff. As of mid-January, 1,303 employees of The Miriam and Rhode Island hospitals have attended one or more education sessions. I would like to thank those who led the sessions and those who attended; your dedication to patient safety always has been and will continue to be one of The Miriam’s greatest assets.

For those who were not able to participate in surgical education day, I would like to review the reporting process in place to ensure the safest environment for our patients. I cannot stress enough the importance of reporting any and all patient safety concerns. You can inform your manager of a concern, call the number 3 – Safe (3-7233) to report a concern, or use the occurrence reporting system. No penalties will be made for voicing a concern. We share the common goal of keeping our patients safe; any issues reported will only serve to improve the patient experience.

The Miriam’s medical staff feels so strongly about the topic, that they have established a Patient Safety Recognition Award. The award, to be given quarterly, will recognize the staff member at The Miriam who made the greatest contribution to patient safety. Staff who report safety concerns, take action to prevent harm or participate in team work to improve systems may be nominated for the award.

Nominations for the award, which has monetary reward of a $250 American Express gift card or a $500 savings bond and hospital recognition, can be found on the intranet. To find the form, start with the administrative tab and find the Lifespan policies page. Look for The Miriam Hospital and click policy and procedure manual and then human resources. The forms are under “general information.” Additionally, the forms are available in human resources. The first quarter ends on March 31st and nominations will be accepted until that point.

Working together, we can improve the patient experience at our hospital. I have seen and admired the dedication and strong work ethic displayed every day at The Miriam Hospital, and am confident they will help us face this challenge head-on, with outstanding results.

Quality Improvement Indicators

Arthur Sampson — Wed, 03 Mar 2010 19:12:52 +0000

We have many ways of judging our success as a hospital. The satisfaction of employees and patients, the number of patients we see, the number of surgeries we perform, our Magnet status and the support of our generous donors. These are all excellent ways to measure our many successes, but we also need other, more detailed ways to gauge our improvements. That is why 4 clinical quality improvement indicators have been chosen for 2010. Some are standing goals that we seek to continually improve each year and others are new. All are specific to The Miriam. Here, I seek to briefly explain each indicator and why it was chosen.

The indictors that were carried over from 2009 are hospital acquired pressure ulcers in critical care patients, falls with injury and antibiotic compliance for patients with severe sepsis and septic shock. The first two are Magnet and National Database of Nursing Quality indicators and are classified as “never events” by the Center for Medicare and Medicaid. The third indicator is important to The Miriam Hospital because evidence shows that timely antibiotics administration improves patient outcomes. Although we had favorable results in 2009, we continue to make these indicators a priority.

The Miriam’s new indicators are pain management and time spent in the emergency department. Pain management is a priority of the Joint Commission and a strong indicator of patient satisfaction. The goal for the emergency department is to transfer ED patients to the ICU in under 90 minutes, which will decrease ED overcrowding, improve patient satisfaction and help improve another quality indicator, antibiotics administration to sepsis patients.

The final indicator is hand hygiene, a multiyear goal for The Miriam. Hospitalized patients are more susceptible to hospital acquired infection and many infections are caused by pathogens transmitted via the unwashed hands of health care workers. Hand hygiene is the single most important procedure for preventing hospital infections. In 2009, we sought a 70 percent compliance with hand hygiene; we achieved 77 percent compliance. This means that 77 percent of the time, our anonymous observers noted that all personnel washed their hands going into and exiting from the observed room. In 2010, we hope to continue that good work and reach a total of 80 percent on our way to 100 percent compliance.

If you have any questions about these indicators, feel free to contact your manager.

Hard work will be needed to accomplish all of these goals. The Miriam, however, is no stranger to hard work. We will meet these goals as we have met many others, and continue to improve the patient experience.

Highlights of the Medical Executive Committee Meeting

TMH News — Fri, 26 Feb 2010 15:33:34 +0000

Notes from the meeting on February 2, 2010.:

TMH/RIH Merger Update
The Merger Committee has been on hiatus. The combined Board is addressing structures of committees

Bylaws Revision Committee Update
Attorney Jay Elias has developed core sections of the bylaws addressing due process, credentialing and staffing categories. The Miriam Hospital MEC has approved $10,000 to retain an attorney to perform an independent review of the core sections. The attorney selection process is ongoing.

Clinical Services Review Committee
Sub-committees in oncology, orthopedics and cardiology have been formed and continue to meet.

Department of Medicine Search
The Department of Medicine search is going well. Final candidates are being interviewed.

Risk Management Update
Joan Flynn is the new vice president for risk management. Lifespan Risk Services is a Lifespan-owned company which specializes in claims handling, insurance administration and loss prevention and education. Types of insurance include professional liability, general liability, employment practice liability, directors and officers, property and privacy.

Quality Report
The MEC will focus on one quality indicator each month. Hospital acquired pressure ulcers was the focus at the February MEC meeting. Hospital-wide patient falls with injury will be the focus at the March MEC meeting.

Meaningful Use
The American Recovery and Reinvestment Act of 2009 and its Title XII, Health Information Technology for Economic and Clinical Health defines funds available to be paid to health care providers for “meaningful use” of health information technology. Financial incentives will be available for the hospitals and for physicians. The Meaningful Use program will improve patient care by providing more information to physicians and other caregivers. Communication to the medical staff about the Meaningful Use program will be forthcoming.

Hospital Acquired Pressure Ulcers
Hospital acquired pressure ulcers is a Magnet Designation indicator. POA pressure ulcers qualify for higher reimbursement and require a note documenting presence and staging by an MD within 48 hours.

Patient Safety Update
The Safety Attitude Questionnaire (SAQ) is an ICU collaborative, specific to the ICU Units. The survey has been administered to all hospitals in the state since 2005. The last survey was issued in November 2009 and was administered to all responsible for patient care; RN, MD, respiratory therapists and charge nurses. Six domains were measured to include safety culture, teamwork climate, perceptions of management, stress recognition, working conditions and job satisfaction. A five point scale was utilized ranging from strongly disagree to strongly agree. TMH had an 88 percent response rate.

Results included:

Financial Report
The December financial statement was reviewed. The hospital was over budget in charity care and bad debt. FTE’s were over by 6-9. YTD performance is behind budget.

From the VPMA/CMO Corner

William Corwin MD — Fri, 26 Feb 2010 15:17:20 +0000

Change is never an easy occurrence for physicians and other providers. However, the remainder of 2010 will provide an inordinate number of opportunities for our staff to change how we work as we strive to meet key implementations to Meaningful Use. The American Recovery and Reinvestment Act (ARRA) and its Health Information Technology for Economic and Clinical Health (HITECH) will drive private practice, clinics, and hospitals to meet implementation deadlines that are challenging. Without diving to deeply into the details it is planned to implement these changes before October 1, 2010. For all involved there is substantial stimulus money on the line ($20 million over 5 years).

This includes:

The use of a Problem List for all patients. Without a “Problem List” on LifeLinks generated by the attending, the lifetime medical record will be considered incomplete. 80 percent of the attending staff must use this tool for 3 months to achieve the standard.

The use of a computer based Clinical Progress Note for all daily notes with same requirements of 80 percent use over a measured 3 month period to achieve the goal. The good news is that the progress note will be pre populated with the Problem List, Vital Signs, Current Labs in the last 24 hours, and the Current and Home medication list.

The implementation of new software to enhance the Medication Reconciliation process and to allow direct order entry of the medications listed in the Home Med List.

Changing the Continuing Care Document (CCD) base on Federal mandates of what needs to be in that document and then making it available to the referring physician or PCP through an IS hub. Just how this new set of requirements will fit with the State of RI’s COC form is not yet clear.

The movement of all Vital Signs from paper to electronic and into LifeLinks.

The requirement that all the nursing plans become electronic as well with the elimination of their traditional paper documents. These nursing documents and notes will also be on line.

A new occurrence reporting tool called GE MERS to replace our current risk management process. This will be accompanied by a training and emphasis on reporting “good catches and near misses” in a standardized fashion. The entire state will be moving to this process to enhance data collection to help direct changes that improve patient safety.

All the above changes will be available for viewing on line in LifeLinks once finished.
If that is not enough, there is a team working on an improved Universal Policy for Lifespan for bedside and procedural areas (Cardiac Cath Lab, EP Lab, Endoscopy, etc) that will that will bring all Lifespan hospitals into compliance with a similar process at each campus much like the operating rooms.

The timeline for all these changes is being determined; however, most will begin in the spring with a deadline around or on October 1, 2010. Hang on for what will be a rocky ride down the IT roller coaster.

Hospital Consumer Assessment of Health Care Provider and Systems (H-CAHPS)

William Corwin MD — Mon, 11 Jan 2010 15:33:57 +0000

The drive towards “transparency” through public reporting in the hospital setting is estimated to set the tone for the future state of health care. Patient satisfaction/experience survey measurement has not been exempt from this demand. To date, publicly reported quality measures, including patient experience, are linked to hospital reimbursement in a “pay for participation” system. However, current “pay for performance” models are under evaluation.

The Hospital Consumer Assessment of Health Care Provider and Systems (H-CAHPS) is the first nationally standardized patient experience survey. The results are available to the general public on the CMS hospital compare website which allows for comparisons across U.S. hospitals. Random selection of discharged inpatient adults (>=18years) from acute care facilities are mailed a survey one week post discharge. Survey responses are patient mix adjusted (PMA) for demographic variables (age; language; etc) and clinical variables (medical; surgical etc). Survey question are arranged in domains for public reporting as follows: communication with doctors; communication with nurses; responsiveness of hospital staff; pain management; communication about medicines; cleanliness of the hospital environment; quietness of the environment; discharge information; overall rating of the hospital and willingness to recommend the hospital. These public report domains display the “best” or top box category % always; or % 9 & 10 “best overall” and % definitely recommend. Results are posted on Hospital Compare typically for 9 months post discharge, representing a cumulative average for the previous 12 months discharges. The information currently updated on Hospital Compare 12/17/2009 is for discharges from April 2008 to March 2009.

The Miriam Hospital, for the current report period, is above or equal to state of Rhode Island averages and national averages for all domains with the exception of one. Quietness of the hospital environment is currently below both state and nation averages. The communication with doctors’ domain has consistently scored 80% always since the inception of the data collection in October of 2006. The Miriam Hospital has consistently ranked well across all domains when compared to state of Rhode Island and the Boston metropolitan area hospitals.

Transparency in the public reporting of patient experience measures to key stakeholders is challenging. The 9 month of lag reports has been a barrier to quality improvement efforts which increasingly require “just in time results.” Lifespan hospitals, while required to use H-CAHPS, also use a patient satisfaction survey tool to bridge this gap, providing monthly data to improvement groups 10 days after the close of the prior month. The current tool to access information for the public via the CMS Hospital Compare website is awkward for the average user. To that end, Lifespan developed a user-friendly one-page document of hospital performance on H-CAHPS available to the general public via hospital external web pages.

Annual Summary of Medication Safety Improvements

TMH News — Mon, 11 Jan 2010 15:25:24 +0000

The Medication Safety Team, with approval of the Pharmacy and Therapeutics Committee, has released the annual summary of medication safety improvements to thank staff for reporting actual, prevented and potential medication errors and to demonstrate the positive effect these reports have made in improving medication safety hospital-wide.

Over the past year, medication error reports, along with national alerts, were the driving force behind hospital wide medication safety improvements, including:

Development and implementation of a new electronic prescribing pathway for oral chemotherapy agents in the Lifespan Physician Order Management (POM) system. These changes improved the safe prescribing, dispensing, administering and monitoring of oral chemotherapy.
Enhancements to improve the safe prescribing, administration and monitoring of heparin infusion protocols, including renaming of protocols to reflect goal PTT ranges, inclusion of weight-based dosing in POM ordering screens, enhanced reporting of PTT values greater than 150 seconds and updating of the heparin infusion protocol dosing adjustment charts to prevent errors during rate changes due to pump programming error.
Issue of a Medication Safety Alert titled “Dilaudid (hydromorphone) = A High Potency Opioid” which calls attention to the high potency nature of hydromorphone and identifies groups of patients who may be at higher risk from narcotic-related adverse events.
Addition of “hard limits” to infusion pumps for 32 high-alert medications administered as IV infusions. These “hard limits” provide alerts for potentially dangerous rates of administration and help prevent errors due to incorrect pump programming.
Weight-based dosing functionality was added to POM ordering screens for several high-alert medications ordered in “mcg/kg/min” to promote standardization and to prevent “free-text” rate errors during prescribing.
Enhancements were made to Siemens Pharmacy system to activate automated screening for food-drug allergies, such as Combivent in patients with peanut allergies and influenza vaccine in patients with egg allergies.
Barcode scanning technology was added during medication dispensing processes as a strategy to maximize the number of MAK-recognized medications available and reduce barcode overrides during medication administration.

Please share this information broadly with staff and use this opportunity to encourage continued reporting of actual, prevented and potential medication errors.

Laminated color copies of the alert will be prominently displayed in patient care areas in locations near automated dispensing machinery (i.e. Omnicell, Pyxis areas).

Please feel free to contact Valerie F. Turco, RPh with any questions or comments regarding this alert.

Welcome Rabbi Hodgetts

Timothy Babineau MD — Thu, 31 Dec 2009 16:50:21 +0000

The Miriam Hospital welcomes Rabbi Janie Hodgetts to the hospital’s multifaith spiritual care team.

Hodgetts provides pastoral care to patients and staff of all faiths. She also serves as an in-house resource to respond to questions and concerns surrounding Judaism and the particular needs of Jewish patients. “We’re committed to maintaining and honoring the Jewish heritage and history of The Miriam Hospital,” says The Miriam’s executive director, Arthur Sampson. “Rabbi Hodgetts brings a wealth of experience, knowledge and passion to our team and will be a valuable resource, not only to our staff, but also to the community that we serve.”

A graduate of Cornell University, Hodgetts received her MBA from Harvard Business School and spent many years in the field of organizational behavior and human resource management. In May 2009, Hodgetts received her ordination as rabbi from Hebrew College Rabbinical School. She completed several chaplaincy and rabbinic internships at organizations throughout New England, including Beth Israel Deaconess Medical Center in Boston. As a member of the Rhode Island Board of Rabbis, Hodgetts works with other rabbis in the Providence community to ensure that Jewish patients at The Miriam Hospital receive optimal spiritual care. She is also available as a Jewish resource for other chaplains and chaplaincy students as part of The Miriam’s relationship with the Chaplaincy Center in Providence.

“I am honored to be a part of a topnotch hospital with such strong Jewish roots that understands the essential role of spiritual care in medicine,” Hodgetts says. “I look forward to working alongside staff who are very energized and committed to providing quality care to patients, and for whom work is not just a job, but in many cases a calling.”