Saturday, April 26, 2008

Green acres

On Earth Day, April 22, twenty-five Community General Hospital employees showed their appreciation of our 42-acres of the planet.

Earth Day is about preserving and protecting the environment, and the Community people did just that. They used part of a beautiful spring afternoon to clean our campus of debris from the past year.

With temperatures near 80 degrees, the team filled some 30 large trash bags with junk. Everything from an air conditioning compressor to old car tires were found, collected and properly disposed of. (Yes, there are obvious questions: who dumps such stuff on our campus and why?)

To spark enthusiasm, there were two medallions hidden on the grounds, entitling the finders to “food-and-a-flick.”

This was our second annual Earth Day celebration to keep the campus green. It is great to see this event becoming part of the Community General tradition.

Here are the names of those who helped (and if you look carefully, you can find most of them in the photo): Jim Aiello, Michelle Berkey, Mike Brown, John Carnowski, Ann Coniski, Kristin Dombroske, Mary Gazarra, Pam Johnson, Kathy Kendrick, Deb Kurtz, Mellissa Martin, Jim O'Brien, Gillian Ottman, Judy Piedmonte, Lynnette Pittinger, Sally Ramsden, Ken Redmore, Linda Rizzo, Joan Russell, Dave Salati, Cecilia Sansone, Nancy Thompson, Tracey Van Dyke, Pauline Warboy, John Zacharek.

My thanks to all who participated in keeping the earth – and Community – beautiful!

Saturday, April 19, 2008

Not me

Several people have asked if the Post-Standard made the mistake last week in its story A health report card, about the HCAHPS survey results. The newspaper attributed Tom Quinn’s comments to the marketing director at Cortland Regional Health Center.

The answer is no, the newspaper did not make a mistake. There is another Tom Quinn, and he works in Cortland, NY.

There are many namesakes, and if you Google “Tom Quinn,” you find pages and pages of us. Tom Quinn, the astronomer. Tom Quinn, the fictional case officer in Britain’s MI5. Tom Quinn, author. Criminal defense lawyer. Film actor.

As a 14-year old, I attended a junior seminary in Pennsylvania. One day after class, I discovered that my name was crudely scratched in a corner of a blackboard. I pointed this out to the priest who taught us Latin. “I didn’t do that,” I sheepishly explained. “I know,” he said with a big grin. “It’s been there for years. Today that Tom Quinn is probably in jail.”

More than medicine

For the first time the federal government is reporting how well hospitals satisfy the patients they care for. These are statistics hospitals have looked at internally, but they’ve never been publicly compared before.

Among Syracuse hospitals, the patients at St. Joseph’s Hospital Health Center gave it somewhat higher satisfaction scores. My congratulations to CEO Ted Pasinski & the staff at St. Joe's. Community General Hospital's patient satisfaction is the next best locally, as reported by the federal Centers for Medicare & Medicaid Services (CMS).

Since last year, all hospitals have been required to submit to CMS the results of their patient satisfaction surveys using a standard methodology called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS, pronounced “H-caps”). Hospitals that fail to submit such data will have their Medicare payments reduced by two percent – so there is an incentive to comply.

Although the HCAHPS scores were posted only recently, the federal government has been developing its patient satisfaction methodology for years. As a matter of fact, Community was one of 132 hospitals nationwide that helped pilot a version of the HCAHPS survey in 2003.

Last month the HCAHPS scores were posted on the CMS website. In the list below are the patients’ scores for Syracuse hospitals for the first five of ten HCAHPS questions. These data are for patients surveyed during the period October 2006 - June 2007.

Nurses always communicate well
Community - 72%
Crouse - 66%
St. Joseph's - 77%
University - 68%

Doctors always communicate well
Community - 78%
Crouse - 73%
St. Joseph's - 77%
University - 73%

Patients always received help as soon as they wanted
Community - 60%
Crouse - 48%
St. Joseph's - 64%
University - 49%

Pain was always well controlled
Community - 65%
Crouse - 61%
St. Joseph's - 68%
University - 63%

Staff always explained about medicine before giving it to patients
Community - 54%
Crouse - 51%
St. Joseph's - 53%
University - 52%

Notice that the government reports the percentage of responses from patients who said they were “always” satisfied with respect to the specific question.

“Always” is a demanding standard. “Always” means a hospital did not fail to meet the patient’s expectations even a single time during the course of a hospital stay. To give this perspective, would your spouse say that he or she is “always” satisfied with the way you manage the finances, discipline the kids, or maintain the lawn? Would your co-workers or your supervisor report they are “always” satisfied with your performance on the job?

HCAHPS scores do not address the underlying issues of quality care, only its social aspects. But hospital care is a mix of clinical processes and interpersonal communications. Hospital care is "more than medicine." I have written before about the importance of two-way communication and the personal touch. [1]

Patients expect hospital quality to be first rate. They expect us to provide the right care to the right patient on time and as promised. They do not expect errors or omissions. Quality care is baseline. It’s what they need us for. But care that is delivered respectfully and with a personal touch is always recognized, always welcomed, and always appreciated.

That is why we acknowledge members of our staff who are especially kind, helpful, and responsive. Our STAR award honors physicians who demonstrate “sensitivity, thoughtfulness, appreciation and respect,” and our WOW award recognizes employees who make “an extra effort” to assure a patient’s needs have been met, even exceeded.

CMS will update the patient scores on its website each quarter. We as an industry – and we as an individual hospital – have more to do to improve the percentage of patients who say we “always” meet their needs.

[1] See these postings on the “More than Medicine” blog: The importance of listening , Stop me if I say something you don’t understand, and Whatever became of bedside manner

Sunday, April 13, 2008

Our Auxiliary gem

We see all around us the good they do, but we may not always recognize how varied are the works of the Auxiliary at our hospital and within our community. [1]

Last week the Healthcare Association of New York State (HANYS) shined a spotlight on the Auxiliary with its Advocacy Recognition Award.

HANYS recognized the Auxilians for all their work – the preventive health screening they conduct within the community, their health care scholarships, the car seat identification program, their support of hospital volunteers, the library cart for patients, as well as the financial assistance the Auxiliary provides to purchase equipment for patients. Last year, for example, the new waiting room furniture in the Emergency Department was purchased with funds donated by the Auxiliary.

A few years ago one of our doctors was at Van Duyn Home and Hospital, our campus neighbor. A nurse told him how grateful she was, these many years later, for the scholarship help the Auxiliary gave her to become a nurse.

One of the more visible parts of the Auxiliary is the main lobby gift shop which provides snacks, sundries, and gifts for patients.

Other examples of the Auxiliary at work? Auxilians maintain the flower beds that make the front of Community General Hospital so pleasant each spring and summer. They sponsor the Holiday Lights on the Hill program each year, helping families and friends honor and memorialize their loved ones during the holiday season. The Auxiliary holds an annual golf tournament, and it provides sales events throughout the year to help employees, volunteers, physicians, and visitors shop for books, toys, clothing, linens, flowers, and jewelry.

Auxilians are especially proud because their organization predates our hospital on Onondaga Hill. The first Auxilians went door-to-door in 1962, inviting friends and neighbors to join them. The then newly-formed Auxiliary led tours at Community for donors and community groups in the months leading up to our opening, January 1, 1963.

This is the second time HANYS has recognized the Auxiliary for its work on behalf of patients at Community General and within the greater Syracuse community. And just last year, the Community Genmeral Foundation saluted the Auxiliary for its 45-year service record at our hospital.

Please acknowledge Dottie DeSimone, Auxiliary President, along with the Auxiliary Board and all Auxilians for the time and energy and funds they contribute to make Community a better place for patients. Please thank Krtistin Dombroske, Director of Volunteers, and her staff for their work in support of the Auxilians. And thank you, HANYS, for shining your light on our Auxiliary gem.

[1] This posting includes some material about the Auxiliary from a previous posting.

Saturday, April 5, 2008

VHA honors ICU for having no VAP cases

Congratulations to the staff and leadership of the Intensive Care Unit (ICU) at Community General Hospital. Because of their accomplishment, our hospital will receive an award for excellence at the VHA Leadership Conference, May 4, in Philadelphia, PA.

The award recognizes Community for having no cases of ventilator-associated pneumonia (VAP) for 12 consecutive months.

I’d like to acknowledge and thank Dr. Russ Acevedo, [1] ICU Medical Director, and the intensivist physicians who practice with him in the ICU. Appreciation also goes to Sue Kompf, RN, Staff Educator and Acting Manager of the ICU, and her staff. My thanks as well to Dr. Mitchell Brodey, Infectious Disease Officer, and to Sue Chamberlain, RN, Director of the Infection Control Program.

VAP is the leading cause of death amongst hospital-acquired infections, exceeding the rate of death due to central line infections, severe sepsis, and respiratory tract infections in the non-intubated patient. Perhaps the most concerning aspect of VAP is the high associated mortality.
An article in Chest, published by the American College of Chest Surgeons, reports that VAP increases the time an ICU patient spends on a mechanical ventilator, as well as adding to the length of a hospital stay even after a patient is discharged from an ICU.

The Society of Critical Care Medicine among others, has identified a “bundle” of activities that “achieve significantly better outcomes when used together,” including elevating the head of the ICU bed, daily “sedation vacations” and assessments of a patient’s readiness for extubation, as well as prophylactic treatment[2] for peptic ulcer disease and deep venous thrombosis (DVT).

Community was notified of the honor by Curt Nonomaque, President and CEO of VHA, Inc., who said, “This award honors organizations that have differentiated themselves around national performance standards by achieving exceptionally high levels of performance.”
It is our second VHA award. In 2006 Community was honored for excellence in the clinical care of patients with heart failure (at left)

Congratulations on this milestone in quality patient care!

[1] Dr. Acevedo also directs the ICU at Crouse Hospital, and he is the chair of the Respiratory Care Network Steering Committee of the American College of Chest Physicians. Congratulations to Crouse Hospital, which will also be honored by the VHA for having no VAP cases in 12 months.
[2] “Prophylaxis” comes from a Greek word that means guarding against or preventing something. In medicine, a prophylactic treatment is a medical or public health procedure that helps prevent disease or injury.