|Under the Microscope: Our Patient Care
What a difference it makes for our patients when physicians fully engage in improvement efforts! In cardiac surgery at St. Mary’s, care is better and safer since blood transfusions have fallen by 80%. Overall outcomes for all patients undergoing cardiac surgery have also dramatically improved.
Cardiac Surgeon Dr. Doug Cowgill led an interdisciplinary team of physicians, nurses, perfusionists and blood bank experts in utilizing the tools of Continuous Quality Improvement to achieve these dramatic results. In 2008, 77% of patients undergoing CABG received a blood product transfusion; today that number is 39%. The average transfusion per patient was 10 units; now the average is less than 2 units.
|This impressive change was initiated by a team doing a detailed study of current practice, evaluating published best practices, developing a change strategy, implementing a pilot and, finally, widely deploying the improvements. This improvement project has been part of a focused effort to achieve “best in class” outcomes for patients needing cardiac surgery. Our results year to date demonstrate a marked reduction in morbidity and mortality such that survival of this complex patient population exceeds national benchmarks. Our surgeons working in collaboration with the rest of the interdisciplinary care team are committed to achieving designation as a “top 100” heart hospital.
What could we do for all of our patients that would have a similar beneficial impact?
In contrast to the stellar results described for cardiac surgery, we have had dismal performance in one of the most simple, yet critically important, aspects of our care for patients. This graph demonstrates our performance in hand hygiene compared to all other hospitals in the SSM system.
Of all disciplines in the hospital mix, physicians have the greatest opportunity to improve. In 1847, Dr. Ignaz Semmelweiss demonstrated that hand hygiene by obstetricians markedly decreased the risk of postpartum infections. Yet, more than 150 years after this discovery and the emergence of ever more resistant bacteria, we still cannot seem to make this simple, effective activity a priority.
I challenge all of the medical staff to demonstrate to our patients and all of the care team that we can lead the way by washing our hands before and after patient contact every time. One of our hospitalists, Dr. Debbie Jones, is working with an interdisciplinary process-improvement team to make certain that effective hand hygiene occurs 100% of the time. But it will take the commitment of all of us.
I ask for your help to achieve results that we will be proud to share with all of the patients who entrust us with their care.
John Butler, MD
BACK TO TOP
Doc Rock is Madison Magazine's Person of the Year
Congratulations to Dr. Bill Rock, who graces the cover of the November issue of Madison Magazine as their 2010 Person of the Year. An article titled “The Good Death” showcases Doc Rock’s unique understanding of death long before he began to take care of the dying as medical director of HospiceCare. The subtitle is “Thanks to him, we know how to live life to the end of life.” To view the article, click here.
Continuity of Care: Medicare Coverage for Nursing Home Care
As our patient population ages and becomes more medically complex, an increasing number of patients may require skilled nursing facility (SNF) (i.e. nursing home) care following hospitalization. In an era of health reform, the rules surrounding Medicare coverage for SNF care are always evolving. Many patients and physicians alike do not fully understand what Medicare covers for SNF care. Read more.
Changes in Epic: Low Microbial vs. Cooked Foods Only; Pre-Dictation Radiology Reports; Care Everywhere
Specific uses of the Epic electronic health record have registered changes. The improvements include a new diet order label, a better process for creating and accessing pre-dictation radiology reports, and the ability to access patients’ records from other health care providers using Epic.
Diet Order in Epic Has New Label
Based on literature research, communication with other inpatient organizations as well as St. Mary’s medical staff, the “Cooked Foods Only” (CFO) modifier has been updated and replaced by "Low Microbial."
“Low Microbial” largely eliminates the fresh/raw food restrictions that were the basis of Cooked Foods Only, which was typically ordered for immunocompromised persons. Similarly, Low Microbial nutrition therapy addresses the food safety concerns of individuals whose immunity is suppressed and at high risk for foodborne illness.
This change in practice now means that St. Mary’s Food and Nutrition Services allows and serves washed raw fruit and vegetable items under Low Microbial. Also notably new is that processed meats such as deli cold cuts are not okay, except in the case of hotdogs where the item is reheated to steaming.
Other exceptions exist: fruits like grapes and strawberries that are prone to harboring mold growth are restricted on Low Microbial, as well as the fresh, refrigerated type of salsa served at St. Mary’s.
Food and Nutrition staff has completely reviewed and adjusted practices to become consistent with accepted Low Microbial guidelines.
Contact Clinical Nutrition staff if you have questions about this update. You may also consult the ADA Manual online, available on St. Mary’s Intranet homepage. The manual details professional and consumer level information for “Low-Microbial Nutrition Therapy.”
Pre-Dictation Radiology Reports Improved
A new process for delivering preliminary interpretations of medical images during evening and weekend hours improves patient safety as well as communication between the radiologist and the referring clinician.
Since mid-October, the new process of delivering preliminary interpretations includes the following:
1. Pre-dictation report will be faxed to either the emergency room or identified nursing units, as in the current process. The improvement is that the patient’s demographics will auto populate into the report and the findings will be typed. This reduces the risk of patient identification error as well as report mismatch and eliminates illegibility issues.
2. The pre-dictation report will then be scanned into Epic under the imaging tab, within 2 hours of the faxed report. This will provide access to the preliminary report via Epic.
Madison Radiologists are committed to delivering accurate and timely service during evening and weekend call hours. In addition to improving communication between the radiologist and the referring clinician, the change reduces the risk of patient ID and report mismatch errors. If you have questions, please call radiologist Dr. Cary Shlimovitz at x6933.
Records Can Now Go Where Patients Go
Patients of Dean Clinic, St. Mary’s Hospital, St. Clare Hospital in Baraboo and four affiliated hospitals in the region will have easier access to their medical records when they visit a different health care provider. That’s because of Care Everywhere, a secure-network sharing module of Epic health care software.
Currently, with patient permission, Care Everywhere allows urgent care and emergency patients’ health information to be exchanged as needed for treatment with any provider in the nation that employs the same software. In Madison, such providers also include Group Health Cooperative, Meriter Hospital and University of Wisconsin Hospital and Clinics. A Madison pilot program proved to be beneficial in urgent care and emergency situations, and plans are in the works for expanding the program to other health care visits.
Grand Rounds Topic: How to Use Epic More Effectively
A Grand Rounds presentation to the medical staff offered educational tips on navigating St. Mary’s electronic health record. For the PowerPoint document, click here.
Physician Spotlight: Alan Schwartzstein
Dr. Alan Schwartzstein is a Family Medicine physician float who is based at Dean Clinic –Oregon. He serves 21 sites across the 18-county service area in multiple primary-care fields, from family and internal medicine to pediatrics and urgent care. The fact that he shares his expertise so widely reflects his love of serving communities through hands-on work and local and statewide leadership roles.
A sampling of other positions:
- Effective February 2011: President of the Wisconsin Academy of Family Physicians
- Clinical Assistant Professor, Department of Family Medicine, UW School of Medicine and Public Health
- Physician member of the merged Board of Health of Madison and Dane County (and chair during the merger process)
- Past president of the Dane County Medical Society
- Officer of the Wisconsin Medical Society
- Preceptor for UW medical students. "I teach them to think of their career in medicine as extending beyond the clinic and surgical suite walls."
- Dean's 2010 Community Service Award
- Safe Harbor’s 2002 Wesley Award for community leadership
- 2001 Public Health Leadership Award
Professional interests are wellness, specifically stemming the tide of pediatric obesity; better collaboration of public health and medical care to cost-effectively advance the health of our community; empathic end-of-life care; and insuring every child in our community has a good, healthy start in life. Outside of my clinical and service work, I enjoy spending time with my family; gardening; playing golf terribly, and enjoying Badgers, Packers and Brewers sports on TV or in person with family and friends. I am proud to be a shareholder of the Packers, but more proud of raising three marvelous children.What makes me most proud:
St. Mary’s has earned its reputation as the community’s hospital, both through excellent medical care and generous support of community activities which improve the health of our community. That understanding of a hospital’s mission makes me proud to call St. Mary’s "my" hospital, and that Dean Clinic has a strong collaborative relationship with it. Special thanks go to
Frank Byrne and Craig Samitt, as well as other previous and current St. Mary’s and Dean leaders, who have been extremely supportive of my efforts to reach beyond the walls of the clinic to serve our community. Also Pete Schmeling of St. Mary’s Foundation was instrumental in helping my wife and I co-found the St. Mary’s Care Center Companion Team, which provides vital empathic support to residents and families in the last days of life. Your 5 Short Answers Will Help Lab Fine-Tune Service
Because “exceptional” is the goal, physicians using St. Mary’s Lab are requested to take a moment to rate your experience. Click here
. BACK TO TOP
New Restraint Policies in EffectUnprecedented Drug Shortages Affect Patient Treatment
The restraint policies have been updated to meet recent CMS guideline changes. Restraints fall into two classifications: non-violent and violent. The policies went into effect October 1, 2010.
The restraint policy has two order sets:
- Restraints non-violent, non-self-destructive: to be used when clinical need requires use of least restrictive method to ensure that patient health and safety are maintained.
- Restraints violent, self-destructive: to be used when there is imminent risk of patients physically harming themselves, staff or others.
What violent restraint use will mean to physicians:
- An immediate call for a physician order.
- A conversation with the physician one hour after application.
- A new order every four hours if there is a continued need.
- A debriefing within 24 hours.
It is important to use an order set rather then a type of restraint. The policies will be available online, and each unit will have a restraint binder for quick reference. If you have any questions, please call Sandy Onsager, 7 SW, 258-5030. BACK TO TOP
What's behind the shortage of approximately 140 medications nationwide? And how does St. Mary's Pharmacy help physicians move forward with their therapies? For an explanation of the situation, read the Pharmacy Newsletter.
Mobile Website Offers Info on Smartphone
St. Mary’s web presence is now easily accessible from any smart phone. A downsized version of stmarysmadison.com features numbers for urgent care and other important services, interactive maps providing directions from the user’s location to the hospital or St. Mary’s Sun Prairie Emergency Center, and a link to careers at St. Mary’s. Soon, the expected wait times for emergency care will also be added to the site. To start using the new mobile site, visit www.stmarysmadison.com from any smartphone and it will redirect you to the mobile version.
St. Mary’s Foundation Gets New Director
This fall marks new leadership for St. Mary’s Foundation with the appointment of Sandy Lampman as executive director. Previously, she served as CEO of the American Red Cross, Badger Chapter; executive director of Ronald McDonald House Charities of Madison; vice president of the HospiceCare Foundation, and director of the Badger State Games. Most immediately, she was executive director of the Great Lakes Hemophilia Foundation in Milwaukee.
Family Care Suites Open House Set
Physicians are invited to a special open house on Wednesday, Dec. 15, to get a sneak peek at the newly expanded and remodeled Family Care Suites. The new unit is now on the hospital’s third floor, making way for expansion and renovation of the NICU and Birth Suites in 2011 and 2012. A community open house will be held from 1 to 4 p.m. Saturday, Dec. 18.
Click the image on the right to view a larger version of the rendering.
Physician Resource Center Back on Track
Originally set for a January completion, the Physician Resource Center is now scheduled to open on A South in March 2011. The wing is under construction to create a physician lounge, dining and kitchen area, non-designated sleeping rooms, coat closet, locker and shower area, physician shared offices, hospitalist office and spaces for medical staff services, Continuing Medical Education (CME) and library services.
Honors and RecognitionsGuardian Angels: Eleven physicians were recognized in the third quarter of 2010 by grateful patients and families for providing exceptional care. Administered by St. Mary’s Foundation, the Guardian Angel program recently added the following physicians to their list of St. Mary’s Guardian Angels:
Congratulations are in order for institutional successes and for our colleagues who go above and beyond the duty of their day (or night) jobs.
Yamil Arbaje (Oncology)
Nicole Christian (Hospitalist)
L. Douglas Cowgill
David DeAngeles (General Surgery)
Santiago Hernandez (Hospitalist)
Lori Wendricks House (Obstetrics/Gynecology)
Jeffrey Masciopinto (Neurosurgery)
Charles Miley (Neurology)
Alan Singer (Cardiology)
Dean Clinic Medical Staff Recognition Awards (click here for full details):
Richard Botham (cardiovascular surgery): Lifetime Achievement Award for retired physicians
Timothy Lechmaier (Internal Medicine): Lifetime Achievement for a currently practicing physician
James Levin (Infectious Disease): Clinical Innovation Award
Alan Schwartzstein (Family Practice): Community Service Award
In his own words: Dr. Andy Kosseff is labeled The Explorer in a profile about his work and his semi-retirement. Log onto ssmpeople.com to learn more about him through pictures and audio or through a story narrative.
Clinical Quality: The national Hospital Quality Incentive Demonstration (HQID) project rewarded St. Mary’s Hospital for delivering high-quality care for heart attacks, surgery and pneumonia in what’s called Pay for Performance. The project, which is sponsored by the Centers for Medicare & Medicaid Services and Premier healthcare, also issued a Top Improver Award (top 20 percent in the country) for St. Mary’s results for coronary bypass surgery and pneumonia.
A Best Place to Work: SSM Health Care, parent organization of St. Mary’s Hospital, has been selected one of the Best Places to Work in Healthcare for 2010, according to Modern Healthcare Magazine. Results are based on a benefits and policies questionnaire completed by SSM and an online survey of 400 randomly selected SSM employees.
Extreme Satisfaction: Stoughton Hospital, an affiliate of St. Mary’s, is one of just five health care facilities in the nation to achieve the 90th percentile or above in all three markers of organizational satisfaction: that of patients, employees and physicians. As a 2010 recipient of the Partner of Choice Award, delivered by a national company that measures satisfaction in health care among 10,000 hospitals, Stoughton was recognized for achieving the 98th percentile for patient satisfaction, the 92nd for employees and the 99th for doctors.
Patient Safety Calendar: Five St. Mary’s Hospital wellness and safety programs are featured in photos of the 2011 calendar distributed by the State of Wisconsin Injured Patients & Families Compensation Fund.
New Faces on the Medical Staff - Click here.