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.

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.

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.”

Sigman is the co-director of the Men’s Health Center at The Miriam as well as a professor of surgery at The Warren Alpert Medical School of Brown University. “Dr. Sigman has been a valuable member of the urology team at both hospitals for more than 10 years,” says Timothy J. Babineau, MD, president and chief executive officer of Rhode Island Hospital and The Miriam Hospital. “His continued commitment to providing the highest quality patient care and his demonstrated expertise and leadership will be a great benefit to the urology departments at both Rhode Island and The Miriam hospitals.”

Sigman succeeds Harry Iannotti, MD, who served as chief of urology at The Miriam Hospital for nearly two decades, and Barry Stein, MD, former chief of urology at Rhode Island Hospital. “Dr. Sigman has worked closely with both his predecessors for many years,” Babineau says. “We believe this is a natural transition, and we thank both Dr. Iannotti and Dr. Stein for their longstanding commitment and for nearly 40 years of combined service and dedication to patients in our community.”

“I am proud to carry on the tradition of excellence in urology at both Rhode Island and The Miriam hospitals and look forward to leading such a dedicated and talented team that is truly committed to delivering the best outcomes for our patients,” says Sigman.

Strong Support For Research

The Miriam Hospital’s Weight Control and Diabetes Research Center (WCDRC) recently received six research grants from the National Institutes of Health (NIH) – totaling more than $12 million in funding – that will support the work of researchers focused on the prevention and treatment of obesity.

Rena R. Wing, PhD, a leader in the field for more than 20 years and director of the WCDRC as well as a professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, is the principal investigator on these grants. “Obesity continues to be the number one health risk facing Americans, and the health consequences and financial burden of this epidemic are devastating,” Wing says. “We are grateful for the support our team has received, which will help strengthen and build on our research programs to develop and study innovative obesity prevention and treatment strategies.”

Funding for three of the grants was made possible by the American Recovery and Reinvestment Act of 2009, including a highly competitive NIH Challenge Grant. Only 200 NIH Challenge Grants were awarded to researchers nationwide out of approximately 20,000 applications.

The largest grant – nearly $6 million over five years – was awarded by the National Heart, Lung and Blood Institute (NHLBI) to compare two behavioral interventions to prevent weight gain in young adults. According to Wing, young adults experience the greatest rate of weight gain – approximately one to two pounds per year – putting them at increased risk for weight-related health problems such as heart disease. “We know it gets harder to lose the weight as you get older, so preventing weight gain during young adulthood is critical to curbing the obesity epidemic,” Wing says.

The goal of Wing’s two-year, $930,320 NIH challenge grant, also funded through NHLBI, is to develop and test an innovative Internet-based program to improve patient adherence to behavioral weight loss regimens. Based on the findings of previous research studies at The Miriam, this program will use interactive, multimedia technology to capture several of the critical elements of effective behavioral weight loss programs. If the program is successful, it would provide a critical resource for physicians to use with their patients. These grants are quite a boon for The Miriam Hospital. With them, the hospital continues to perform the innovative research so integral to our mission as an academic medical center. If you would like to learn more about these and other studies, please visit WeightResearch.org.

The Miriam Hospital earned a Gold Performance Award from the American Heart Association and American Stroke Association in recognition for achieving 85 percent on key measures for two years or more, and once again we were awarded a United Health Premium Cardiac Specialty Center designation. To receive this designation, the hospital satisfied extensive quality and outcomes criteria based on nationally recognized medical standards and expert advice.

The Adele R. Decof Comprehensive Cancer Center at The Miriam Hospital and the Comprehensive Cancer Center at Rhode Island Hospital received three-year accreditation from the National Accreditation Program for Breast Centers, and were two of first three breast centers in New England to earn the coveted accreditation.

The Miriam’s pulmonary rehabilitation program became the first in the state to be accredited by the American Association of Cardiovascular and Pulmonary Rehabilitation. The Miriam Hospital’s echocardiography lab was accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories in recognition of its commitment to high quality patient care and diagnostic imaging, and the computed tomography department was awarded three-year accreditation by the American College of Radiology.

The nuclear medicine laboratory also received two national accreditations from the Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories, and is one of the country’s first hospital-based nuclear medicine laboratories to be accredited for both general nuclear medicine and nuclear cardiology. The year saw physicians appointed to new positions, including Martin Miner, MD, who was named chair of the department of family and community medicine; William Cioffi, MD, who was named surgeon-in-chief, and Mark Sigman, MD, who was named chief of urology. Additionally, Kwame Dapaah- Afriyie, MD, FACP, was named director of The Miriam’s hospitalist program and Frank Sellke, MD, FACS, was named chief of cardiothoracic surgery.

While many of our achievements and announcements were significant, it is clear that one of the biggest announcements in fiscal year 2009 was the merger of Rhode Island Hospital and The Miriam Hospital. This strategic initiative will enhance our ability to fulfill our academic mission and make sure that we remain competitive locally and regionally in this rapidly evolving health care landscape. The recently announced affiliation between Memorial Hospital and Brigham and Women’s Hospital in Boston for cardiac care and emergency services is a stark reminder that “business as usual” no longer defines our local health care environment and will not be a winning strategy for either Rhode Island Hospital or The Miriam Hospital. I will keep you informed in future communications as to the progress of several of the working groups that are underway on this merger.

The Miriam’s myriad accomplishments are the direct result of the talent, dedication and hard work of the staff at this extraordinary hospital. I am confident that 2010 will see The Miriam Hospital continue to succeed.

As 2009 comes to a close, I would once again like to thank Kathleen Hittner, MD, for her years of service and exceptional leadership. My best wishes to you and your loved ones for a safe and happy holiday season and a joyous new year. In the steadfast pursuit of excellence,

I remain sincerely yours,
Timothy J. Babineau, MD

President and Chief Executive Officer
The Miriam Hospital and
Rhode Island Hospital

Rena R. Wing, PhD, a leader in the field for more than 20 years and director of the WCDRC as well as a professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, is the principal investigator on these grants. “Obesity continues to be the number one health risk facing Americans, and the health consequences and financial burden of this epidemic are devastating,” Wing says. “We are grateful for the support our team has received, which will help strengthen and build on our research programs to develop and study innovative obesity prevention and treatment strategies.”

Funding for three of the grants was made possible by the American Recovery and Reinvestment Act of 2009, including a highly competitive NIH Challenge Grant. Only 200 NIH Challenge Grants were awarded to researchers nationwide out of approximately 20,000 applications.

The largest grant – nearly $6 million over five years – was awarded by the National Heart, Lung and Blood Institute (NHLBI) to compare two behavioral interventions to prevent weight gain in young adults. According to Wing, young adults experience the greatest rate of weight gain – approximately one to two pounds per year – putting them at increased risk for weight-related health problems such as heart disease. “We know it gets harder to lose the weight as you get older, so preventing weight gain during young adulthood is critical to curbing the obesity epidemic,” Wing says.

The goal of Wing’s two-year, $930,320 NIH challenge grant, also funded through NHLBI, is to develop and test an innovative Internet-based program to improve patient adherence to behavioral weight loss regimens. Based on the findings of previous research studies at The Miriam, this program will use interactive, multimedia technology to capture several of the critical elements of effective behavioral weight loss programs. If the program is successful, it would provide a critical resource for physicians to use with their patients. These grants are quite a boon for The Miriam Hospital. With them, the hospital continues to perform the innovative research so integral to our mission as an academic medical center. If you would like to learn more about these and other studies, please visit WeightResearch.org.

The newly constructed nuclear medicine department at The Miriam Hospital opened in March, and boasts experienced staff and a warm environment conducive to positive patient experiences. The Miriam also expanded its interventional radiology services, which treat many conditions, including stroke, vascular disease, cancer and gastrointestinal and gynecological conditions.

An exciting new addition to our cardiac catheterization suite is the electrophysiology and peripheral vascular interventional lab, which opened last October. Since then, nearly 100 patients with rhythm disturbances, such as slow heart rates or life-threatening tachycardia, now receive sophisticated device therapy, such as implantation of pacemakers and defibrillators, in this new lab.

The past year has seen improvements that always keep the patient in mind. I congratulate each and every one of you on a job well done. I foresee great things at The Miriam in the months to come, and I wish you and yours much health and happiness in the new year.

Sincerely,
Arthur J. Sampson
Executive Director, The Miriam Hospital

I am writing to update you on the work of the Clinical Services Review Committee. This committee met three times over the past several months and engaged in very helpful dialogue on the state of the clinical services on both the TMH and RIH campuses.

We also discussed our vision for the future as an outstanding teaching hospital on two campuses, and what makes sense for our new combined organization. The physicians and support staff who have been involved in this process have been thoughtful, open minded and creative in their thinking. Our principles are very clear, and include the imperatives to achieve new levels of clinical excellence across both campuses, to advance the ability of two vibrant acute care hospitals to serve our communities, and to achieve levels of operations and capital expenditures that are more effective and in line with our fiscal responsibilities.

While the work of this review process is far from complete, we have identified a number of clinical programs that have the potential to benefit from consolidation on one or the other campuses. Among the major service lines that were discussed are orthopedic surgery, including spine surgery and major joint reconstruction, specialized cancer services, cardiac surgery and complex interventional cardiology. During the coming weeks, I will convene several work groups to examine the different options in greater detail. As usual, we will seek broad-based participation to inform this work. No definitive conclusions have yet been reached. In the first half of 2010, I hope to be able to advance a set of clinically integrated programs that will better support our mission, vision, and principles.

Once again, I would like to personally thank the steering committee participants who have invested many hours of their time and intellect and passion on this critical topic.

Thank you and best wishes to all for happy holidays.

In the steadfast pursuit of excellence, I remain sincerely yours,

Timothy J. Babineau, MD
President and CEO, Rhode Island Hospital and The Miriam Hospital

MEC Merger: The respective staff associations and MECs cannot merge until the hospitals have been granted a single license by the RI Department of Health. In the interest of preparing both groups in advance of that merger, Peter Karczmar, MD (vice president) and I have initiated a series of meetings with our counterparts at RIH, Tom DiPetrillo, MD (president) and Dan Levine (president elect) to begin formulating the composition of a combined MEC and the alignment and composition of the various staff association committees. The CMOs of each of the hospitals have also participated in the discussions. These meetings have been very efficient and have gone very smoothly. Although the details of the proposed formulation have not been finalized and are yet to be presented to anyone outside of the active participants, suffice it to say that TMH will have significant representation of the new MEC and the reconfigured committees and sub-committees.

Merger Committee: Six (6) members of the TMH Board of Trustees, including myself, and six (6) members of the RIH Board of Trustees have been meeting with George Vecchione, Tim Babineau and Ken Arnold from Lifespan legal department to go over all aspects of the hospital merger. Topics have included bylaws, committee structure, and naming of the new institution. All of these are slowly progressing, and it is clear that the full merger may not take place until late 2010 and possibly 2011.

Clinical Service Review Committee: Eleven (11) representatives from both hospitals have been meeting with an outside consulting firm, Kurt Salmon and Associates, to discuss the pros and cons of merging some clinical services at the two campuses. The meetings have been an overview of the two campuses and the clinical services and discussion of potential consolidation. I strongly urge you to contact me with your opinion of shifting programs.

Schiffman was trained as a hematologist/oncologist at Yale and the National Cancer Institute, and his patients, family and friends with serious hematologic problems have helped to shape the way he approaches these illnesses. This experience of being on the other side of the stethoscope combines with his clinical expertise and teaching skills to make him the physician he is today. Schiffman is a graduate of New York University School of Medicine and has cared for patients at The Miriam since 1983. He is the associate physician-in-chief at The Miriam Hospital, vice-chair of the department of medicine at The Warren Alpert Medical School of Brown University and medical director of the Lifespan Comprehensive Cancer Center. He is also the associate program director of the Categorical and Preliminary Medicine Training Programs at The Warren Alpert Medical School of Brown University. As part of that job, he meets with residents each morning and works closely with them and the medical chief residents throughout the day.

He balances all of these responsibilities, he says, “because I work with wonderful people.” Principal among them is Eleanor Aloisio, his hardworking assistant. Schiffman is vocal about his appreciation for others with whom he works, especially Dominick Tammaro, MD, medical residency program director, Edward Wing, MD, former physician-in chief and current medical school dean, and Lance Dworkin, MD, current interim chief. Without their efforts, he says, day to day life at the hospital could not run as smoothly. He also credits his success to those who have had the greatest influence on him: his parents, who were both teachers; his mentors from medical school; and Charles Carpenter, MD, whom he says has “guided generations of physicians.” “If I am well-regarded,” he continues, “it goes back to these people.”

Schiffman, despite his many and varied duties, holds treating his patients most dear. “It is a pleasure and an honor to see patients,” he says. Perhaps that is why he goes on to say, “I’m most proud of our cancer center’s multidisciplinary clinics.” The clinics take a collaborative approach to care and allow patients to receive treatment at single sites. The Comprehensive Cancer Center currently has a urologic oncology clinic located at The Miriam Hospital. Several subspecialty tumor boards are underway, and a multidisciplinary thoracic oncology clinic is planned for the new year. The clinic will be a collaborative effort of The Miriam and Rhode Island hospitals and will demonstrate the cooperation of thoracic surgery, radiation oncology and medical oncology. In addition to physicians and surgeons, the clinic will also offer the services of nurse practitioners, social workers, navigators and nutritionists. Each patient will receive exceptional care—always the heart of Schiffman’s work.