Wednesday, October 31, 2007

If you read nothing else...

Today’s Post-Standard reports that more than 200 Central New Yorkers probably died as a result of hospital acquired infections in 2004. The number comes from Excellus BlueCross BlueSheild, which made the estimate “based on data from the federal Centers for Disease Control and Prevention and other sources.”

I have previously posted comments about hospitals and infections, including Community General Hospital’s own infection rates and recent efforts to improve hand hygiene compliance. See: All fish swim in the same water, Weird glowing substances, A tale of two cities.

If you read nothing else, A tipping point deserves your attention. It contains the obituary of a Canadian gentleman who died as the result of a hospital-acquired infection. Please read it all the way through.

All fish swim in the same water

Before I began the blog, I wrote weekly messages as short letters to the employees, physicians, volunteers, and auxilians of Community General Hospital – to all the members of the CGH family. Hand washing, infection control, and standard precautions have been consistent themes. Here are excepts of past letters that have not been posted as blog entries.

From “All fish swim in the same water,” March 5, 2005
“If you saw a co-worker or someone from another department fail to wash hands, what do you do? Be embarrassed for them? Bite your tongue and say nothing? I suggest that you say something, such as: ‘Excuse me, did you forget to wash your hands? You must have a lot on your mind – just trying to help.’

“The fact is, hand washing is often done privately. Most of the time there is no one to remind us, just a sign (on the wall)…and that little voice in our heads that tells us to do the right thing. All of us who work in health care share the responsibility for keeping our patients and our co-workers safe. That responsibility starts with hand washing….

“In the aquarium all fish swim in the same water. In our world, we breathe the same air and touch the same surfaces. We touch our patients. Hand washing is not something to take for granted.”

From “Why the obsession about hand washing?,” March 19, 2005
“Nationally, statistics show hospital personnel comply with hand washing requirements only 54% of the time. That is shocking. At CGH our compliance last year averaged 90%. That is almost twice the national rate, but it is not good enough. Even a single instance of noncompliance could put an employee or a patient at risk of infection.”

From “A culture of safety,” July 3, 2005
“Last month the State Legislature passed a bill that will require hospitals to report publicly infection rates for surgical wound infections and for bloodstream infections related to central lines in ICU patients…..

“This particular bill received a lot of attention statewide and across the nation, thanks to publicity generated by the Committee to Reduce Infection Deaths (‘RID’), a non-profit organization that has worked to require the public reporting of hospital infection rates. I wrote to RID earlier this year in support of its efforts…”

From “Not Halloween masks,” October 29, 2005
“As you can see, [hand hygiene] compliance in October is 95%. That sounds great, but consider this as you look around the cafeteria. Of the 99 other people there, who are the five who, on average, fail to wash their hands? When it comes to infection control, we cannot be satisfied with 95% – 100% has to be the goal.”

That's Mitchell Brodey, MD, Hospital Epidemiologist, in the photo, above. Actually, it's a photo of the life-size cutout of Dr. Brodey that makes its way around the hospital to remind everyone at CGH about the importance of hand washing. Dr. Brodey's doppelganger has been "on duty" since September, a companion to the life-size cutout of Sue Chamberlain, RN, CGH's Infection Control Program Director, who has "patrolling" the halls and departments since July.

Compelling hospital stories

Please check out Running a Hospital, the notable blog from Paul Levy, President & CEO of Beth Israel Deaconess Medical Center in Boston. Paul is the pioneer of hospital CEO bloggers, notable for the insights, the candor, and the sheer abundance of his entries.

Yesterday he hosted a "Grand Rounds" posting that linked commentaries on experiences at hospitals that changed someone’s behavior or beliefs. Many compelling stories there.

Sunday, October 28, 2007

Diamonds & Denim

Last Friday evening the Community General Foundation held its annual, informal gala at the OnCenter in Syracuse with the theme “Diamonds & Denim.” The nearly 600 in attendance contributed some $189,000 to the fundraiser.

In his opening remarks Gala Committee Co-chair Mark Re, Vice President & General Manager of Gallinger RealtyUSA, said:
The “denim” is a symbol of people who roll up their sleeves and work to make a difference. The “diamonds” symbolize people who sparkle with accomplishment.
Honors were awarded for special accomplishments to the medical profession, to the community, and to Community General Hospital. The photo shows, from left, Mark Re, Dr. Drew Merritt (one of those honored ), and me.

The proceeds from Diamonds & Denim will help CGH upgrade its medical technology, including:

▪ New high-definition video equipment to improve the ability of surgeons to peer inside the body as they operate with miniature surgical tools that reduce injury and speed patient recovery;

▪ An upgraded, multi-slice CT (computerized tomography) scanner that brings faster and new imaging tests to our patients; and

▪ A state-of-the-art computerized physician order entry (CPOE) system using patient safety features available at only about ten percent of the nation’s hospitals.

The multislice CT is already in use. The high-definition video will be in place before year-end, and physicians will begin to use the new CPOE system in 2008.

We do not take for granted the support of donors to the Foundation. Thank you for your support, which directly benefits the patients of Community General Hospital.

My special thanks to Steve Johnson, Chair of the Foundation; to Gala Committee Co-chairs, Mark Re and Kim Dynka; to the Auxiliary for organizing the charity auction – and to all the volunteers who made it a fun night!

Medical arrogance

My thanks to Dr. Paul Kronenberg, President and CEO of Crouse Hospital, for his op-ed piece on “medical arrogance” in today’s Post-Standard. Dr. Kronenberg writes:
Hospitals are run by people, and people make mistakes. We don't always listen as well as we should. And yes, we sometimes fail to live up to the expectations of our patients and their family members.

Effective communications between caregivers and patients (and among the caregivers themselves) are not just a matter of politeness. Poor communications raise the risk that something is misunderstood, that something is missed – this can foster medical errors.

Dr. Kronenberg is right to emphasize the importance of caregiver communications. For more on this, see these past postings – Stop me if I say something you don’t understand, The importance of listening, and Whatever became of bedside manner?

Saturday, October 27, 2007

The flu, "a patient safety issue"

A few days ago Dr. Richard Daines, the New York State Commissioner of Health, sent a “Dear Colleague” letter to health care providers across the state.

In it he emphasized the importance of flu shots for health care workers, saying it is "a patient safety issue":
Unvaccinated HCP (health care personnel) have been implicated in the spread of influenza and outbreaks in every type of health care setting. In fact, the failure to adequately immunize HCP is a patient safety issue in all health care facilities, including home care and ambulatory care settings. Low vaccination rates among HCP are associated with an increased number of outbreaks, poor patient outcomes, and increased employee absenteeism. Despite this, HCP vaccination rates remain low.
I recently wrote about the flu vaccination clinic for employees.

In addition to the clinic, Sue Chamberlain, Infection Control Program Director, will bring the vaccination cart to work sites throughout CGH during the week of November 4 – this will make it even easier for employees to receive the vaccine.

CGH will also hold a flu clinic for employees’ family members on Saturday, November 17. This exercise will help test out hospital’s organization for the prompt dispensing of shots, as may be needed in an emergency situation.

There are many reasons to get the flu vaccine: to protect ourselves, to protect our families, and to protect our patients.

Friday, October 26, 2007

That flu bug

A couple years ago Sue Chamberlain, CGH’s Infection Control Program Director, accompanied by a cart full of supplies, appeared at my office door.

“Did you get your flu shot?” she asked, knowing the answer. Then she admonished me: “You have to set an example.” So I signed the consent, rolled up my sleeve, and had the shot.

I have been, uh, setting an example ever since.

This fall Sue is again leading the charge to inoculate the maximum number of hospital staff, and this time she’s enlisted the help of Dan Cameron, graphic designer.

Dan created his own version of the flu bug, as displayed on posters around the hospital and on computer splash screens. He's even included that flu bug in the hospital’s logo. Gone is the disc fir trees, symbolic of our beautiful campus. That disc in the logo has been replaced by a flu bug in surrender!

The next time flu shots will be offered for CGH employees: 6:30 - 10:00 a.m., November 2, in the Employee Health Office.

Saturday, October 20, 2007

More on the doctor shortage

I recently wrote about the growing shortage of physicians.

Dr. David Duggan of SUNY Upstate Medical University has brought to my attention documentation about the physician workforce shortage at the website of the Association of American Medical Colleges (AAMC). From the website:
Given the extended time required to increase U.S. medical school capacity, and to educate and train physicians, the nation must begin now to increase medical school and GME [Graduate Medical Education] capacity to meet the needs of the nation in 2015 and beyond.
The AAMC website includes Recent Studies and Reports on Physician Shortages in the U.S., a 10-page paper that identifies studies across the nation that document the physician shortage – from Arizona (“Still far below the national average”) to Wisconsin (“Who will care for our patients?”).

Monday, October 15, 2007

Worthy honorees

In about two weeks the Community General Foundation will honor a number of people for service to Central New York: Dr. Drew Merritt, the Auxiliary to Community General Hospital, and Local #43 of the IBEW.

The honors will be given at the Foundation’s annual gala, October 26, at the OnCenter in Syracuse. The gala’s theme is “Diamonds and Denim,” which seems to have left many people wondering just exactly what to wear. Blue jeans are OK, and I’ve heard people will wear “washed black denim” too. Western gear is fine – as, of course, are diamonds or otherwise sparkly things. The bottom line: attendance at the gala does not require formal attire.

In fact, informality is a hallmark of the annual gala. And that means the evening’s presentations are mercifully short too. The emphasis is on raising money for a good cause by dining, dancing, and enjoying the company of friends. Tickets are still available. Just call 492- 5079.

For service to profession, Dr. Merritt
Dr. Merritt, pictured below, will be honored for his service to the medical profession. He is a past president of the Community General Hospital Medical Staff who recently served as interim Vice President of Medical Affairs and Chief Medical Officer.

Dr. Merritt is Vice-Chair of the Department of Family Practice, a member and past president of the New York State Chapter of the American Academy of Family Physicians (AAFP), a member and past president of the Onondaga County Medical Society, and a member of the Medical Society of the State of New York (MSSNY), where he serves as chair of MSSNY Committee on Health Care, is an alternate delegate to national AAFP, and serves on the AAFP Commission on Practice Enhancement.

Beyond his roles in medicine, Dr. Merritt has served the community as a member of several organizations affiliated with the Town of Marcellus and as a coach for youth sports. He and his wife, Carol (who is also being honored), have three daughters - all of whom were born at Community General Hospital.

For service to hospital, the Auxiliary
The Auxiliary will be honored for 45 years of service to CGH. An important part of the hospital, the Auxiliary helps raise funds and provides community services. Since inception, the Auxiliary has donated over $2 million to the hospital, designating funds to such items as renovations to the Surgery Center, the Jim and DeDe Walsh Family Birth Center, and medical equipment in various patient care services.

The Auxiliary provides blood pressure screenings throughout the community and advocates for health care issues in Albany.

The group photo shows members of the Auxiliary’s Executive Committee, from left: Ted Topalian; Mary Lascaris; Carol Merritt, outgoing President; Kay Cudworth; Dottie DeSimone, incoming President; and Claire Wightman. Not shown are committee members Bernie Schmidt and Donald White. CGH is a very family-oriented place, and isn’t it fitting that both Drew and Carol Merritt will be honored on the same evening?

For service to community, IBEW Local #43
Being honored for service to community is the International Brotherhood of Electrical Workers, IBEW Local #43. Chartered in 1896, the union represents some 1,200 members, including quality electricians in Central New York. In the photo are Don Morgan, Local #43’s President, and Bill Towsley, its Business Manger.
The local chapter contributes to the Community General Foundation’s capital campaign that provides funds for capital projects such as the physical medicine & rehabilitation unit, the Jim & DeDe Family Birth Center, and the cardiac catheterization lab. Local #43 also supports the Foundation’s annual pro-am golf tournament as “presenting sponsor” for the past five years. Beyond its support of CGH, Local #43 assists numerous charitable causes throughout Central New York, with members regularly taking part in local fund raisers and volunteer work.

These are good people who have accomplished much for good causes. Please join me in saluting these worthy honorees.

Saturday, October 13, 2007

An image of beauty and peace

Tom Watson is a photographer from Skaneateles, NY, who uses satellite image technology to take beautiful, sweeping panoramic photographs. A few months ago, he spent time in Community General Hospital when a loved one was hospitalized here, and he noticed a poster of an Ansel Adams photograph on Four North, across from room 456.

As Mr. Watson explained to me:

My wife, Sue, and I spent the afternoon at the beginning of my career with Ansel Adams and his wife, Virginia. His work has inspired me, his books have taught me and if he were alive today, I believe he would be working in the same (digital) technology that I do now.

Mr. Watson has donated one of his own digital photographs to the Four North waiting area, across from the public elevators. “I hope that it will also bring comfort to others attending their loved ones at CGH,” he said.

On my rounds this morning, I visited Four North and studied Mr. Watson’s five-by-two-foot print of Hesperis Matronalis,[1] shown above. When the illumination is complete and a plaque in place, we will have a small ceremony to acknowledge Mr. Watson’s generosity.

I am no expert on photography, but I know that Ansel Adams was remarkable as an artist, not just for his eye, which captured the grandeur of nature, but for his technique, which combined in a single photograph richly evocative shadows and brilliant highlights.

“We have digital image tools that Mr. Adams never imagined, but would wholeheartedly embrace. He was an artist and a technician,” explains Tom Watson in IATH Best Practices Guide to Digital Panoramic Photography[2]

Mr. Watson uses those digital tools to create his own detail-rich photos that capture the dynamics of light, dark, and color. When you are on Four North, take a moment to study the texture of the tree bark in Mr. Watson’s photograph. Then examine the colors of the lilacs, the sunlight on the tree leaves, and the shadows of the woods.

A smaller, signed print of Hesperis Matronalis is being offered as a premium gift to all who make donations of $250 or more in this fall’s Circle of Friends campaign, being conducted by the Community General Foundation. Other examples of Mr. Watson’s high-definition digital images may be seen in articles about him in Wired and AIArchitect.

Thank you, Tom Watson, for the gift of your art, which brings to our clinical world an image of beauty and peace.

- - - -

[1] Tom Watson explains: “This photograph, Hesperis Matronalis, represents 4 trips and 8 hours standing behind the camera waiting for the optimum conditions. I produced at least 20 different image files to then narrow my selection to this one image. This continuous panorama (no stitching) could only be produced with a view camera and a scanning, 144 mega pixel digital back.”

[2] In IATH Best Practices Guide to Digital Panoramic Photography, see section 2.5 and find the text written by Tom Watson. Go to Figure 6, a panoramic view of the Academical Village at the University of Virginia. By repeatedly clicking on the image, you zoom in to discover the many people present, each one very much an individual.

Tuesday, October 2, 2007

State funds will help compliance with Berger Commission

This morning’s Post Standard reports the allocation of $12.8 million of New York State HEAL NY funds for Community General Hospital and Van Duyn Home and Hospital. These funds will be used to comply with the requirements of the Berger Commission. I’ve written before about the Berger Commission.

The funds are necessary because the Berger Commission requires the affiliation of CGH and Van Duyn. These changes are part of a larger state plan affecting 74 institutions – the closure of nine hospitals and seven nursing homes, plus changes in the affiliations or bed configurations of another 48 hospitals and 14 nursing homes.

The state’s decision to fund changes at CGH and Van Duyn comes after many months of dialogue between CGH and Onondaga County, the operator of Van Duyn. County Executive Nick Pirro and his staff fought diligently for the affiliation scenario called “A,” under which the County would continue to own and operate Van Duyn. Scenario “B” would have involved the more complex and more costly process of transferring the ownership of Van Duyn to CGH. Both Onondaga County and the Civil Service Employees Association (CSEA) sued New York State to prevent such a change in ownership.

Our discussions with the County have been straightforward and cordial throughout this process. We have also had a number of discussions with the state, and these too have been helpful. The state remained noncommittal about scenarios “A” and “B” until about 5:00 p.m. last Friday, September 28, when it faxed the announcement of its grant allocation to the County and to CGH.

Although the state has not formally accepted scenario “A,” the funds it has allocated are based on the costs identified for “A” – so “A” appears to be the de facto decision of the state. Here is a summary of what the scenario “A” affiliation involves:

  1. CGH and Onondaga County will create a new not-for-profit corporation, called the Onondaga Hill Corporation (OHC) to conduct strategic planning for CGH and Van Duyn. The OHC’s plans are intended to create operating efficiencies, to improve organizational effectiveness, and to develop a more integrated continuum of care on the CGH-Van Duyn medical campus.
  2. Van Duyn will remain a county-owned facility, subject to OHC planning activity. CGH will remain a private, not-for-profit organization with its planning also subject to the OHC. Both CGH and Onondaga County will appoint OHC directors, with CGH designating the majority of them.
  3. CGH and the County will decertify a total 63 long term care beds. Van Duyn will decertify 13 beds, and Community General will ultimately close its 50-bed skilled nursing facility, converting that space into fully renovated acute hospital capacity. After these changes, there will remain 513 long term care beds on the campus, all of them at Van Duyn. (The Berger Commission did not require any change in CGH’s licensed 306 acute care beds.)

The state funds will reimburse Onondaga County and CGH for the legal and planning costs incurred in complying with the Berger Commission. The funds will also cover the transition costs involved in closing CGH’s 50-bed long term care unit, they will fund the planning work of the OHC, and they will fund facility renovations at both CGH and Van Duyn that are consistent with the Berger Report.

Changes for nursing home residents can be disruptive and stressful. That means we need careful plans for the closure of CGH’s sixth floor skilled nursing unit. These plans have yet to be developed, and they too will be subject to approval by the State Health Department. We are committed to assuring that transitions for residents and their families are fair and respectful.

Of CGH’s 1,200 employees, about 50 will be affected by the closing of the sixth floor long term care beds. These employees may be eligible for positions elsewhere in the hospital, and we expect some may transition to Van Duyn or other community long-term care facilities. We will do our best to communicate fully with employees and to work with SEIU1199 in assuring fair and respectful transition opportunities.

You’ll notice I’ve used the word “allocation,” not “award,” in describing the HEAL NY funds. That’s because there are a number of steps to be completed before the state money is actually awarded and paid. These steps include state approval of a work plan and the sign-off by the Office of Comptroller, among other things.

The state’s decision to fund compliance comes 10 months after the Commission issued its report. It is a necessary step. It is a positive step. But it isn’t the end of the process – only the beginning.