Dr. Goldberg & the Syracuse Healthcare Quality Forum

April 22 will mark the first time four hospital medical staffs will co-host the Syracuse Healthcare Quality Forum.

For Dr. Fred Goldberg this will be the eighth time he has produced such an educational (and inspirational) panel of national experts in health care quality.

Fred is the VP for Medical Affairs and Chief Medical Officer (CMO) at Community General Hospital. When he joined Community in mid-2007, he brought with him a passion for quality improvement – and the idea that Syracuse hospitals should cooperate in educating and motivating ourselves in quality improvement.

Dr. Goldberg previously served as Chief Medical Officer at Faxton-St. Luke’s Healthcare, where he organized its first quality forum in October 2002. That became an annual tradition in the Utica area. When Fred proposed such a forum here, the medical directors at other hospitals enthusiastically supported the idea. Together they planned the Aprill 22nd event, that is being supported with funds from the medical staffs at Community, Crouse, St. Joseph's, and University hospitals.

The Syracuse Healthcare Quality Forum is free, and registration is on-line. The line-up of quality experts is first rate:

• Tamra E. Merryman, RN, MSN, FACHE, Chief Quality Officer, University of Pittsburgh Medical Center, will speak on “Transformation of Care at the Bedside.”

• Harvey V. Fineberg, MD, PhD, President, Institute of Medicine. His topic: “Patient Safety and Quality, the Unfinished Agenda.”

• David Nash, MD, Professor and Chairman, Department of Health Policy Jefferson Medical College of Thomas Jefferson University, will discuss “Leadership for Quality and Safety.”

• James P. Bagian, MD, PE,Human Factors and Patient Safety Expert/Veteran NASA Astronaut. His presentation is entitled, “Getting Stellar Clinical Results: It’s Not Rocket Science.”

The Syracuse Healthcare Quality Forum will be presented from 1:00 – 6:30 p.m., April 22, at the Nicholas J. Pirro Convention Center at OnCenter in downtown Syracuse. It is intended for those in the caring professions and for health care leaders.

Of MASH & history

Thirty 8th and 9th grade students spent two days at Community General Hospital this week learning about health care professions.

These bright, curious, and busy youngsters from MASH Camp were a delight to see in our departments and hallways. The photo, at left, shows MASH Campers in the ED. There were nearly twice as many youngsters as last year.

You can see Syracuse television coverage the MASH Camp at this link.

I spent a few minutes with the campers on Thursday morning. My role was to talk a bit about hospital administration so . . . I took a few props with me.

One prop was my daily schedule for February 18, the previous day. I hoped this would give the young people an idea about how I occupy my time, starting with my daily visit to the emergency department at about 5:30 a.m.

Another prop was the packet of materials I'd just mailed to the Board of Directors. This 101-page document includes copies of board and committee minutes, monthly reports on hospital operations, the quarterly quality report card, year-end financial reports, and briefing documents about decisions the Board will consider. I asked the MASH Campers if a teacher ever assigns them a 100-page book to read over the weekend – that is one of the things the volunteer directors do to help govern our hospital.

Then I showed the campers a 100-year old book from the Syracuse Homeopathic Hospital, our predecessor institution (photo, at right). The 517-page book measures 9 by 15 inches, and when the light catches the cover in a certain way, you can see "Pt Register & Summary” in faded script from a hand practiced in Palmer Method. The book’s brittle, yellow pages contain information about the hospitals’ patients, starting with a 29-year old woman who was admitted on September 4, 1999 and concluding with a 52-year old man who entered the hospital on June 20, 1908.

That old book gave me the opportunity to talk about our roots. Syracuse Homeopathic Hospital, started in 1895 and became General Hospital of Greater Syracuse in 1921. In 1964 General Hospital merged with the Community Hospital on Onondaga Hill to form today’s Community General Hospital of Greater Syracuse.

General Hospital was converted into Castle Rest Nursing Home in the 1960’s. When Castle Rest was razed in 1999 to make way for a new nursing home, I stopped at the demolition site to retrieve a brick from the old edifice, a part of our institutional history.

When I held up the brick (at left), my last prop, I asked the MASH Campers how old they were in 1999. The answer: three to four years old.

MASH stands for the Medical Academy of Science and Health, and Community runs this special program for junior high school students each year during the February break week. Maybe a few of the MASH Campers will be providing me with health care in another ten years.

85% of employees were vaccinated

State Health Commissioner Richard Daines was in Syracuse last week to meet with hospital CEOs and their staffs about community health issues. One of Dr. Daines' questions: what percentage of hospital employees received the flu vaccination?

At Community General, 85% of our active employees were vaccinated this season, and that's up from our 73% vaccination rate last year. In addition, Community immunized over 400 members of employee families and the medical staff.

I've written before about the importance of the herd effect in preventing influenza among hospital patients and staff.

Congratulations to the staffs of Community's Infection Control and Employee Health Offices, as well as to the nursing leaders who assisted in achieving the 85%. And thanks, especially, to employees who recognize their responsibility to patients and staff in helping prevent the spread of influenza.

Nationally the average flu vaccination rate for hospital employees was 44% during the 2007-2008 flu season.

More cool

This is cool.
Today's New York Time's website includes a Times Topic page about the Centers for Disease Control that links to David Rothman's blog.

David is Community's librarian and a very popular blogger (obviously).

In December I wrote about David's new book Internet Cool Tools for Physicians.

Diversion hours were 39% lower last year

Last year diversion hours at Community General's emergency department (ED) fell from an average of 6.9 hours per day (2007) to 4.4 hours (2008). That’s a reduction of 39%. And things were better during the fourth quarter when Community's diversion hours dropped from an average 8.5 hours a day to 2.2 hours, a 74% decline.

Syracuse hospitals generally did a better job last year of providing access to emergency care. Collectively the four non-federal hospitals reduced diversion hours by 10% in 2008 -- and by 57% in the fourth quarter.

When a hospital is “on diversion,” its emergency department asks ambulances to “divert” emergency patients elsewhere. If all Syracuse hospitals happen to be on diversion simultaneously, then the emergency medical system (EMS) directs ambulances to each hospital in sequence.

Diversion occurs when there is an imbalance between patient demand and hospital capacity. If too many patients seek care for the size of an ED or its staff, a hospital may request diversion until a balance is restored. Sometimes an internal event (for example, water line break) may prompt diversion status.

When hospitals are on diversion, a patient seeking care at one hospital may end up at another, at a place where her doctors are not available and where her medical records are not at hand. That’s why the American College of Emergency Physicians, among others, has guidelines for ambulance diversion.

Even when on diversion, however, a hospital's ED is not actually closed. Every emergency department will accept a patient who presents herself for emergency care at any time. A patient has the right to insist that an ambulance go to the hospital of her choice, irrespective of diversion status.

Through the Hospital Executive Council (HEC), a planning agency, Syracuse hospitals have worked together to understand and reduce diversion hours. Funded by the hospitals, the HEC shares data, conducts analyses, and helps support cooperative initiatives to improve health care efficiency and quality.

Diversion is not only about emergency department issues. Does a patient remain in the ED longer than necessary while waiting for a hospital bed to become available? Is a hospital’s length of stay extended because of delays in tests or test reports, because of the time it takes to prepare a room for the next patient, or because patients cannot readily be transferred to nursing homes? Diversion is an indicator of the flow and efficiency of, not just a hospital, but of the health care system within a community.

Here’s an interesting note: last month Massachusetts ordered hospitals to stop diversion, except in specific cases. Syracuse hospitals have reduced, but not eliminated, diversion hours, and we’ve done so voluntarily and cooperatively.

It will be interesting to see the experience of Massachusetts with its regulatory approach.