Life lessons

Congratulations to seven-year olds John, Joseph and Madison Riccardi, and to their older brother Tom Riccardi, who started it all.

Playing as a team, the second graders placed eighth in their division at a national chess tournament in Houston, TX in December. A sophomore at Marcellus High School, Tom has six national U.S. Chess Federation titles to his credit.

All are the children of Dr. Tim and Sue Riccardi, and I remember those kids as toddlers. I haven’t seen them in years, but I’ve followed their chess careers in the Post-Standard, including yesterday’s story and photos (click on Photos of the Day: 01.30.08).

It's a great human interest story, their winning ways, and it's a story of family togetherness. There was an item of particular interest in yesterday's report – how the players learn from their mistakes. According to Sue,

Chess has given the triplets a lot of self-confidence, and it's taught them critical thinking. It's also taught John how to lose…[H]e's seen he can learn from (losses).

The family uses dinner time to consider games that have been lost, using a display chessboard on which Tim recreates the sequence of moves. "It's fun to figure out what moves I should have made," Joe is quoted as saying. "It helps me a lot." What a life lesson!

Dr. Tim Riccardi is the Chair of Ophthalmology at Community General Hospital.

Congratulations to Bill and Lew Allyn, who were honored in the January 2008 issue of Repertoire Magazine, a publication for medical product distributors. The Allyns were the third generation of leadership at Welch Allyn, a company noted for quality products and community service.

The magazine publisher notes that Bill and Lew Allyn

were great stewards of their family business who consistently did things the right way for the right reasons…. They kept the company in upstate New York, even though it is not a business-friendly state in terms of taxation, energy costs and regulation. They were extremely generous with their time and resources, giving and continue to give, to a large number of local and national causes. And through all of it, they maintained a family culture that embraced everyone who worked for the company, including the distributors who sold the company’s products.

Bill, who was a long time member of the Board of Directors of Community General Hospital, continues to be interested in hospital affairs. Since his retirement, Community has been served by two excellent Welch Allyn executives: past Board member Louise McDonald, Executive Vice President & President, International, and current member Kevin Cahill, Executive Vice President & Chief Financial Officer.

The magazine’s honor is a well-deserved tribute to the Allyn brothers and to the quality-focused, community-minded company they served so well.

Smoke and fire

Smoke in the corridor – visibility was, maybe, 25 yards. There were patients in there!

That is my memory from perhaps 15 years ago when an elevator motor fire caused smoke on a patient floor. It was a brief episode, readily addressed by Community General Hospital's Fire Brigade. No one was hurt. No one had to be moved.

But I still remember the momentary panic in my stomach as I saw smoke in the corridor.

Yesterday Community had two fire alarms, one right after the other. The first was a fire drill about 10:30 a.m. The second alarm, coming just minutes later, was triggered when someone, smelling an odor, pulled the fire box. Coming after one another, the alarms caused uncertainty – just as there would be in a real emergency.

It’s because of the potential for confusion and uncertainty that Community has procedures for all to follow during an alarm. One of the first procedures is to close all doors and stay where you are. When I was new to the hospital, that rule seemed counterintuitive to me – shouldn’t we open the doors and get out?

No.

Hospitals are constructed in compartments that can withstand a fire for a matter of hours. That means, if it was the real thing, the fire itself could be contained in a single area, allowing time to get patients (and ourselves) to safety in an orderly way.

But if the integrity of a compartment is broken, fire or smoke can spread, dangerously shortening the time and ability we have to get patients out of harm’s way. That is why following procedures during a fire alarm is so important.

Yesterday, one of the fire alarm monitors told me she was distressed to find an employee, and later, a visitor trying to walk down a corridor during the alarm, despite the monitor’s request to please stay put. That is dangerous. People traffic has to stop during a fire alarm. The air system shuts down. Doors have to remain closed. The integrity of compartments must be maintained.

That is the reason we have drills – to practice how to behave in a real emergency, as if from habit. A drill has to be treated as the real thing, every single time, because our behavior during a fire alarm is the best protection we have for patients, for coworkers, and for ourselves.

Lift Every Voice

The song was already 68 years old when I heard it for the first time.

I listened to “Lift Every Voice and Sing,” also called the African American National Anthem, at a memorial service for Dr. Martin Luther King, Jr. that I attended in April 1968. It is a brooding, soaring, and inspirational piece of music. I was embarrassed at the time that I did not know the words.

Monday is the national holiday that honors Dr. King, one of the truly heroic figures of my time.

When “Life Every Voice” was written in 1900, there were Jim Crow laws in America, and they were enforced in some states as late as 1965. Lynchings were commonplace in the first half of the 20th Century. The Ku Klux Klan continued as a formidable presence well into my lifetime.

I remember being at a band concert one night when I was perhaps ten years old. I overheard two men talking, one trying to impress the other with a story from his childhood – his father had taken him as a young boy to see a lynching. He told the man that he didn't see the actual lynching, but he did arrive in time to see someone drive "a hot poker through the body" as it hung from the tree. I was horrified to hear such a description and dismayed that a parent would be part of it, let alone expose his child to it.

A few years ago, Pam Johnson, Community General’s CFO wrote a letter to her fellow employees about tolerance and diversity, and she spoke about her own experiences and how her views were shaped during Dr. King’s years:

My parents were active in the civil rights movement in the 50s and 60s….

I had a childhood of door-to-door voter registration drives, protest marches, and rallies….My parents’ neighbors would not let their kids play with me in “protest” over my parents having people of color at our house. My father was badly beat up one night for his efforts in registering people to vote….

How ugly, how incredible, as we look back now, that such circumstances could have existed in this country.

Dr. King is a central figure in our history. He helped change not only the laws of America but also the hearts of many Americans. Let us remember and honor him.

What's best for baby?

“Did you really need that C-section?” asked the headline in last Sunday’s Post-Standard. The story reported that “about one of every three babies born at Syracuse’s two biggest hospitals is being delivered by Caesarian section surgery.”

The newspaper reported that a number of factors contribute to the C-section rate, including life threatening emergencies, patient convenience, medical malpractice risk, and possibly economic factors.

Community General's C-section rate was 24.4% last year (through September). I also checked our rate for the recent past: 24.7% (2006) and 26.0% (2005). That means, about one-quarter of the babies born at Community are delivered by C-section, somewhat lower than the 30%-plus rate experienced nationally and reported in the Post-Standard.

Community's total C-section rate is made up of two parts: primary C-sections (that is, first time deliveries) and repeat C-Sections. The primary rate for Community was 16.6% (2005) and 14.2% (2006). I don’t have the final numbers yet for 2007.

Following the news report, I checked recent literature on VBACs (vaginal birth after previous C-section). A report by Drs. Ecker and Frigoletto in the New England Journal of Medicine last year suggested that the national C-section rate is the result of forces more complicated than patient convenience or the profit motive. The authors said:

A more dispassionate analysis, however, reveals that the [C-section] trend is widespread, crossing state and national boundaries, and suggests that multiple, convergent factors are responsible, including changes in patients and their pregnancies, in options and recommendations for delivery, and in patients' and providers' expectations and evaluation of risk.

Drs. Ecker and Frigoletto note that obesity rates have doubled among childbearing women in the past two decades, that childbearing women are older, and that there has been an increase in “the number of premature and low birth-weight neonates,” all factors that push up the C-section rate.

The authors also report that breech deliveries are not recommended because of potential newborn injuries, and that the use of forceps and vacuum extraction has declined due to “better data describing the complications” associated with such procedures.

There are risks associated with C-sections themselves, and the doctors cite them in their article: the potential for an infection, potential damage to the pelvic organs, and possible future reproductive problems. Ultimately, say the authors, the decision to have a C-section (or, having had one, the decision to attempt a VBAC) comes down to a patient’s and physician’s judgment about risks.

As practicing obstetricians, we find that the risk that women are now willing to assume in exchange for a measure of potential benefit, especially for the neonate, has changed: for many, the level of risk of an adverse outcome that was tolerated in the past to avoid cesarean delivery is no longer acceptable, and the threshold number needed to treat has thus been reset.

As an editorial writer in the New England Journal of Medicine put it a few years ago: “After a thorough discussion of the risks and benefits of attempting a vaginal delivery after cesarean section, a patient might ask, 'But doctor, what is the safest thing for my baby?'"

Happy new year

It’s New Year’s Day, and one of my tasks is to compose a report for the semi-annual medical staff meeting that will be held in one week.

I start by reviewing the monthly reports to the board of directors. This helps me focus on the operational, policy, and strategic issues that are the substance of the 1,500 words I write for the staff. I also look at my remarks from past meetings.

From these notes, here are some of the 2007 highlights at Community General Hospital.

■ Community General Hospital was named a Thomson 100 Top Hospitals Performance Improvement Leader.

■ Community’s strong performance in orthopedics was again recognized by a national hospital rating organization -- especially with respect to hip fractures, hip and knee replacements, spine surgery, and overall orthopedic care. I encourage you to research Community General Hospital’s ratings by conducting your own Google search, entering the key words Hospital Ratings. Our orthopedic volume grew some 25% last year.

■ The Joint Commission re-accredited Community for a full three-year term.

■ We completed an agreement with Onondaga County that complies with the requirements of New York State’s Commission on Healthcare Facilities in the 21st Century (the Berger Commission). We received notice of a $12.8 million grant to help Community and Van Duyn Home & Hospital (which is owned by the county) undertake joint planning for our medical campus – and to make the changes in our physical plants as recommended by the Commission.

■ We took a number of steps to improve patient safety, including improving water safety (reducing risks associated with Legionella); improving hand hygiene (through education, awareness, and monitoring); improving medications safety (by starting to implement computerized physician order entry (CPOE); improving interventions for patients at risk (with a rapid response team); improving bed rail safety (new side rails to prevent the entrapment of elderly or disabled patients); and improving accountability (with a new quality report card for board members).

■ We received a $200,000 grant from State Senator John DeFrancisco that is being used to help acquire our full PACS conversion. PACS stands for picture archiving and communication system, and it means that starting this year we will have all-digital image use and storage in the medical imaging department.

■ Our Jim & DeDe Walsh Family Birthing Center was honored with a design award for King & King Architects LLP from the American Society of Interior Design (ASID). King & King designed the unit that was renovated with the help of a $1 million federal grant obtained by Congressman Jim Walsh.

■ Oh, and I began this blog as the successor to the weekly letter I have written to employees and other members of the Community family since 2002.

Happy New Year!

[1] HealthGrades® requires hospitals to pay a significant licensing fee if they are to publicize its findings, so I won’t report them here. But anyone can look up our scores on the HealthGrades® website.