CAPH/SNI
Annual Management Excellence Award Winners
2005
TOP HONORS
Responding Effectively During a Communications or PR Challenge: San Mateo Medical Center, “Crisis Communications – Talking Publicly About Medical Errors”
In August, 2004, the San Mateo County Board of Supervisors announced in a public meeting that a patient had died at the San Mateo Medical Center due to a medication error. The Medical Center needed to respond quickly and skillfully—to the public; to its employees, physicians, and volunteers; to its patients; and to the fundraising Foundation. A small team of key leaders had been meeting to determine corrective actions and key messages before this announcement. All communications were designed to convey and reinforce sorrow and compassion for the patient’s family; responsibility for the tragic event; support for employees, physicians and volunteers; actions being taken to prevent this type of error from happening again; context that medical errors are not unique to the San Mateo Medical Center, and the organization’s values of service, dignity, integrity and excellence. The team selected communications tools appropriate to each audience, with significant visibility by the CEO, Medical Director of Quality and Director of Marketing & Communications. Overall, the Medical Center was able to accentuate positive aspects of its response and prevent coverage that may have been more damaging to its reputation and maybe even its survival. Feedback from several audiences was very positive.
Utilizing Technology to Improve Patient Care: San Francisco General Hospital, “ Mobile Eye Service”
Glaucoma and diabetic eye disease are the leading causes of blindness in the United States ; however, loss of sight from these diseases can often be prevented with early detection and treatment. Although there appears to be ample ophthalmic care in San Francisco , underserved populations exist. These populations are disproportionately affected by eye disease and due to financial, cultural, and transportation issues do not receive the care they need. Diabetic patients, who utilize the Community Health Network of San Francisco (CHN) public safety net system, are disproportionately affected by access concerns and issues of financial, cultural, and transportation barriers for their eye care. The aims of the SFGH Mobile Eye Van Diabetic Eye services are to 1) improve the access, 2) reduce wait time and 3) improve the quality of care for diabetic patients by providing an annual ophthalmic eye exam within neighborhoods where patients reside.
San Francisco General Hospital and the Community Health Network implemented an alternative method to the traditional method of diabetic eye screening that required patients to 1) go to the ophthalmologic office; 2) have their eyes dilated; and then 3) visually inspected by an ophthalmologist without any permanent visual records. Instead of referring patients to the SFGH ophthalmology clinic, The UCSF Department of Ophthalmology at San Francisco General Hospital Medical Center (SFGHMC), in collaboration with the San Francisco Department of Public Health (SF DPH), has established a mobile eye service (Eye Van). The 28-foot eye clinic on wheels is equipped with the latest technology and makes weekly visits to 9 SF DPH Health Centers that serve low-income families, the elderly, and the homeless to provide comprehensive ophthalmic screening.
The responses from primary care providers and patients to the Eye Van have been overwhelmingly positive. The services for diabetic eye screenings are more efficient, are more culturally and linguistically appropriate, and the appointment slots are more readily available. In addition, the SFGH ophthalmology department has been able to store photos of the diabetic patient eyes in a database system and then referred diabetic patients who needed more advanced interventions when it is necessary to SFGH.
Improving Patient Safety: LAC+USC, “An Innovative Approach to Enhancing Communication of Critical Laboratory Results to Providers through Risk Prioritization and Process Improvement”
When properly implemented, the reporting of critical laboratory values (CLVs) promotes timely initiation of lifesaving treatment, but frequently there are problems in conveying CLVs to a patient’s physician. A team of clinicians and other staff at LAC+USC conducted an analysis of the process used to report CLVs and identified steps in the process most in need of improvement. They implemented a variety of system improvements: The CLV notification process was centralized in the Customer Service Center (CSC). Staff in the CSC were trained in using a new CLV computer notification program that included contact information for patients and providers and options for providing follow-up care after-hours, if necessary. Now CSC staff notify providers of the CLVs; assist providers in contacting patients; arrange follow-up visits if necessary; and document the entire process using an electronic abstract form that is printed and filed in the patient’s health record. Under the old CLV notification process, the monthly average CLV notification time was 38 minutes; the redesigned process reduced the process to 5 minutes.
Reducing Emergency Department Utilization: Riverside County Regional Medical Center, “Rapid Medical Evaluation”
The RME project is a break from the traditional, and often rigid, emergency department’s patient flow practice, to one in which the patient is treated almost as soon as they enter into the emergency department utilizing a fluid, and changing process. The program objectives to RME are to decrease patient wait times to see a provider; improve patient satisfaction; reduce the number of patients leaving without being seen; and improved employee morale. The RME project was implemented in August of 2004.
Under the RME approach, the treatment of patients is as follows: First, a quick registration is performed. Next, an initial assessment is performed in the RME waiting area or an open ED bed by a physician and nurse team. The treatment process begins immediately with the ordering of labs, x-rays, pharmaceuticals, and in some cases rapid discharge. The complete registration is performed by mobile staff using a wireless PC.
With over a year of data from the RME project, results are positive. RCRMC has witnessed a decrease in average ED wait time from nearly two hours to under one hour from entry to the ED to initial physician contact. They have also decreased the percentage of walk-away patients from 6% to 3%. Communication with patients and providers has improved, thereby bolstering staff morale and increasing patient satisfaction.
HONORABLE MENTIONS
Reducing Emergency Department Utilization: Santa Clara Valley Health and Hospital System, “Improving Patient Flow: Institution RN Medical Screening Examinations”
Santa Clara Valley Medical Center (SCVMC) planned and implemented an Emergency Department (ED) Registered Nurse (RN) Medical Screening Examination (MSE) program. The goal was to disimpact the ED and ensure patients receive the care they are requesting. Throughout this process the ED paid particular attention to the Emergency Medical Treatment and Active Labor Act (EMTALA, 1988). The target population includes all patients arriving to the ED. On October 2003, SCVMC Administration issued a mandate to plan/implement an RN MSE process. The MSE Steering Committee comprised of ED/Ambulatory Care nursing, physician and administration staff began meeting weekly. By August 2004, ED MSE RNs began performing medical screening examinations 12 hours a day. MSE became a 24-hour process, January 2005. Appropriate physical examinations are conducted in a redesigned room near the triage area. Patients are given appointments in Ambulatory Care Clinics.
Measurable outcomes include: decrease in ambulance diversion hours, reduced elopements and reduced overall length of stays. Of the approximately 200 patients who present to the ED every day, eighty patients are deferred to a more appropriate clinical location. Representatives from the ED, Ambulatory Care, and Hospital Administration have developed an effective MSE plan.
Using Technology to Improve Patient Care: Arrowhead Regional Medical Center, “A System Ripe for Change”
Arrowhead Regional Medical Center (ARMC) is a 373-bed hospital with approximately 100,000 patient visits per year in its’ Emergency Department (ED). Faced with a daily average of more than 270 patients, the ED had problems with long patient wait times for non-emergent care. In 2003, a core group of staff was gathered to evaluate the current process and develop a means to reduce ED wait time for those non-emergent patient visits. An initial assessment revealed that too much time was spent during the triage process on the collection of redundant patient information through a non-computerized data collection process. In addition, the Group determined that the registration staff spent too much time rewriting demographic and financial information for patients when there were multiple visits by the same patient within short periods of time (frequently several per week); there was a lack of consistency in triage methodology due to differing mix of training, outcomes, and experience; there was difficulty by the staff reading the information documented on paper; and finally, there was an increase of non-emergent ED visits left without being seen by a physician due to long wait times. As a result of these findings, ARMC’S goal was to ensure the timely and efficient movement of patients into and throughout the hospital; to match hospital resources; and to improve staff productivity through an increase in automated data collection.
CONGRATULATIONS TO OUR WINNERS!
