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St. V incent TimesMARCH 2012 publication of St. Vincent Medical Center

RespectCompassionateServiceSimplicityAdvocacyforthePoorInventivenesstoInfinityVINCENTIANVALUES:

• House C linic and SVM C Enter Into Co- Management Agreement

• Charting the Way to Excellent Profiles

• Hourly Rounding

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1sthospitalinLosAngeles

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COVER STORYPhysicians who are working with CDI specialists are raising their “physician profiles” and benefiting in many other ways. Paperless office pioneers also are raising their profiles and earning incentives too. Page 4

HOUSE CLINIC-SVMC WORK TOGETHERHouse Clinic and SVMC have entered into a co-management agreement to expand neurotology and neurosurgery services, maintaining the highest quality and efficiency of care. Page 3

HOURLY ROUNDING EVERY DAYPatient satisfaction depends upon good communication and frequent interaction with nurses and other caregivers. Hourly rounding is a proactive approach, steeped in the tradition of caring. Page 8

St. Vincent Times is a publication for St. Vincent Medical Staff and Associates. Please submit articles as soon as possible prior to or after an event for the earliest inclusion in the newsletter by e-mailing information to SharonGreengold@DOCHS.org or by calling (213) 484-5593. Medical Staff submissions may also be sent to SusanLauzier@DOCHS.org. Or call (213) 484-5525.

Ronald S. Fishbach, MD – chief of medical staff

Cathy Fickes – president/chief executive officer Sr. Mary Hale, DC – chairman of the board

MARCH 2012

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sthefirsthospitalinLosAngelesandtheonlyCatholichospitalin

thegreaterLosAngelesmetroarea,wehavehistoryandtraditiontoguideus.AtSt.Vincent’s,wetakecareofthesickwhoneedourservices.Someofourpatientscomefromfaraway.Recently,theArchbishopofNewark,N.J.askedforhelponbehalfofalittlegirlinhisparish.ThechildwasflowntoSt.Vincent’sforararesurgicalprocedure,performedbyophthalmicplasticsurgeonRobertLevine,MD.ThankstoDr.Levineforansweringthecallforhelpalongwithus.

NursingleadershipandallofourassociatescontinuetopracticeStuderGroupprinciples:engaginginhourlypatientrounding,embracingculturaldifferences,andcollaboratingmosteffectivelyontheunits.Wemonitorourpatientsatisfactionresultscloselyandevaluatepatientresponsestoprovidefeedbackonimprovingcare.Whathelpsthemostishavingourcultureofcaringwithafocusonthebestpatientexperience.Thisfollowsabasiclifetenet,“Treatothersasyouwouldwanttobetreated.”

Weworkeverydaytogiveourpatientsthekindofexperiencethattheywould“always”recommendtotheirfriends.Ourgoalis100percentsatisfactionforeachpatientandhis/herfamily.Wemustcontinuehourlyroundingandcommunicatingwithourpatientsaboutwhatwe’redoingandwhywe’redoingittoprovideabetterunderstandingoftheircare.

SVMCalsoisactivelyworkingonbusinessdevelopmentprojects,expandinglinesofservicelikeneurotology,neurosurgery,orthopaedics,cardiaccare,andsurgicaloncology.InFebruary,SVMCandtheHouseClinicenteredintoaco-managementagreementthatwillhelpexpandtheservicesbeyondperceivedgeographicalbarriersandhelpmorepeople.

PrimarycareisanotherstrategicfocusforSVMC,oneofthemostcomplexandall-encompassingservices.Everydepartmentandancillaryserviceinthehospitalworkstoprovidethepatientcareandfollow-throughthatourprimarycarephysiciansexpectwhentheyadmitapatienttoSVMC.

Asweenterabeautifulspringseason,letusallkeepworkingandcaring,andleadingtheway.SVT

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g o t c o n c e r n s ?Physicians may report safety or quality of care concerns:

physician Quality hotline: (213) 207-5783.

Call the values line at (800) 371-2176 or go online at www.dchsvaluesline.org to report concerns

confidentially and anonymously.

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TwoofLosAngeles’soldestandmostvenerablehealthcareinstitutionshaveformallyjoinedforcesinauniquebusinessandclinicaloperationalpartnershiptoextendaccesstohighlyspecializedcareforthosewithhearingandskullbasemedicalproblems.

Theprincipalpurposeoftheco-managementagreementistoimprovequalityandefficiencyofcareprovidedtopatientsatSVMCsothatthehospitalmayrenderthehighestqualityofcareconsistentwiththebestinterestsofthepatientandinfurtheranceofthehospital’scharitablemission.

TheHouseClinic’soutstandingdeliveryofcareandexcellentoutcomeshaveearnednationalattentionandcontributedtothe2011-2012nationalqualityrankingearnedbySt.VincentMedicalCenterforEar,Nose&Throatservices,accordingtoU.S. News & World Report,basedonasurveybytheCentersforMedicare&MedicaidServices(CMS).

“Thispartnershipagreementisatremendousmilestoneinourmissiontoprovidethecommunitywiththehighestqualityofmedicalcareavailabletoday,”saidSVMCPresident/CEOCathyFickes.“ThephysiciansoftheHouseClinicandthehospitalhaveworkedside-by-sidefordecades,buttodaywebeginaneweraofcollaborationtoexpandandimprovetheclinicalcareforthosewithhearingandrelatedissues,”shesaid.

MillionsofpeopleworldwidehavebeentouchedbytheadvancesmadebytheHouseClinicphysicians.Innovationslikethecochlearimplantdeviceandthedevelopmentofmicrosurgicaltechniqueshavemadearealimpactontheartoftreatingpeoplewithhearing,balanceandothersensoryconditions.

SomepatientstravelveryfartoseekdiagnosisandtreatmentattheHouseClinic.Also,HouseClinicphysicianstraveltheworld,teachingandproviding

trainingtootherphysiciansinunderdevelopednations.

TheHouseClinichasastaffofabout100,including10surgeonswhoarefellowship-trainedinotologyorneurosurgery,andmorethan15audiologistsandotherhearingdiagnosticanddispensaryspecialists.BesidesthedowntownLosAngelesfacility,theHouseClinicalsohasasatelliteofficeinOrangeCountyandhearingdispensariesintheSanFernandoValley,SantaMonicaandBakersfield.

TheHouseClinicservesasaclinicaltrainingaffiliateoftheKeckSchoolofMedicine,providinginstructioninotologyforotolaryngologyresidentsatLAC+USCMedicalCenter.Morethan22,000physicianshavereceivedtrainingintheHouseClinicandHRIfacilities.

Aspartoftheagreement,St.VincentMedicalCenterwillserveasabusinessandclinicalpartnerwiththephysiciansofHouseClinic.Thehospitalwilllocategrowthopportunitiesfortheneurotology-neurosurgeryservicelineandworkwithHouseClinictoimplementclinicaloperationalefficienciestosupportthemutualgoalsofthepartnership.

“WehavecalledSt.VincentMedicalCenterhomeformorethanhalfacentury,”saidJohnW.House,MDoftheHouseClinic.“Thisuniquepartnershipwillallowourgrouptofocusontheexceptionalclinicalcareweprovideourpatientsandcontinueourcommitmenttoresearch,”hesaid.“Byworkingintandem,wecantogetherachievebetterpatientcarethroughputandmaintainourtopclinicaloutcomes.”SVT

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expansion: neurotology-neurosurgery

Women&Spirit:CatholicSistersinAmericaexhibitopenedinJanuaryatTheCaliforniaMuseum,1020OStreetinSacramento.SponsoredbytheLeadershipConferenceofWomenReligious,thiscomprehensiveexhibitfeaturesmorethan70artifactsfrom400Sistercommunities.

TravelthroughtimeandexperiencetheCivilWar,1906Earthquake,CivilRightsMovementandotherdefiningnationaleventsasseenthroughtheeyesoftheAmericanwomenwhohelpedshapeourcountry’ssocialandculturallandscape.Formoreinformation,visitwww.womenandspirit.organdwww.CaliforniaMuseum.org.SVT

mission integrat ion

DaughtersofCharity,ProvinceoftheWestwillberepresentedinthissix-monthexhibit.

TheHouseInstitutebuiding,whichincludestheworld-renownedHouseResearchInstituteandtheHouseClinic,isat2100W.3rdStreet,acrossfromSt.VincentMedicalCenter.

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C D I E f f o r t H e l p s P h y s i c i a n s M a s t e r N e w Vo c a b u l a r yIt’smorethanamatterofsemantics.WordsarepowertoolsintheClinicalDocumentationImprovement(CDI)effort.CDIisafieldthatbringstogetherelementsofmedicalrecords-keeping,practicemanagement,andevenmarketing.Properdocumentationreflectsthehardworkandexcellentclinicalachievementsofphysiciansonadailybasis.

Itisaprocessofone-on-oneinterventionsanddiscussionsbetweenCDIspecialistsandphysiciansaboutcharting.Thegoalisaccuracyandtheeffortisallinthedetails.Indocumentation,itisimportanttocreatearealisticpictureoftheartofmedicine:thecomplexityofdiseasesandtheacutemanifestationsofchronicillnesses.Throughproperdocumentation,SVMCphysicianshaveanopportunitytomaintainawell-deservedpositivephysicianprofileinthenewageofonlinerankings.OngoingdocumentationeffortshaveplacedSVMCinthenationalrankingsforqualityofcare.

Inthefuture,rankingsorprofilesofhospitalsandphysicianswillbepubliclyaccessibleonwebsites.Calculatedbyhealthcareregulatory

agenciesandpostedbyhealthplansforpublicviewing,physicianprofilesandhospitalprofileswillreflect,inpart,theacuityofeachpatientrelativetothepatient’slengthofstay.Improvingclinicaldocumentationwithmoreaccuratedescriptionsofhighacuityinpatientailmentswillhelpbuildaccurateprofilesofhospitalsandphysicians.

AnexampleofwhattheCDIteamdoesduringchartreviewistoscanfortermsthatarecommonlyusedinterchangeably,like“incisional”and“excisional.”ThecorrectICD.9-CMTMcodingdescriptionforremovingnecrotictissuefromawoundshouldbe“excisionaldebridement”ratherthan“incisionaldebridement.”

“Doctorsareconservativeandthetermstheyusearetheonesthey’veknownforalongtime.Sotheyarenowfamiliarizingandupdatingtheirterminology,”saidCDIspecialistKathyAnnArde,RN.Sherelatedhowshehadhelpedaphysiciantocodeproperly:“Hewasn’tsurewhethertowritedownMIbecausehehadn’tyetdeterminedthat.SoIsuggestedheconsiderwriting‘possible/probable/suspected’,asitcanstill

becodeduntilruledout.”

CDIspecialistAaronDay,RNnotedthatphysiciansaretrulyinterestedinimprovingtheirdocumentation.“Eversinceweintroducedthemtothedocumentationtipsspecifictotheirspecialty,manydoctorshavedroppedtheirolddocumentationhabits.”Onephysicianwasparticularlyinterestedinhelpingthehospitalincreaseitsprofileandimprovinghisdocumentation.“Heinvitedustocometohisofficetoexplainwhatweweredoingandhowwecanhelphimdocumentbetter,”herecalled.

SVMC’sCDIspecialistsKathyAnnandAaronhaveateamofphysicianchampionsbehindthem.Theteamdeliversadailydoseofdocumentationreviewsandqueries.“Thephysicianleadership,providedbyDr.FayeMontegrande,Dr.AlanJasper,andDr.BrianKahn,isessentialtotheprogramandhelpsgarnerengagementthroughoutthehouse,”saidLoriSeargeant,DirectorofHealthInformationManagementandCDI.“Itisallaboutbuildingtrustandgoodrelationshipswiththephysicians,”saidLori.“AaronandKathyAnnhavebuiltagoodrapportwithourphysicians,whoseethemasavaluableresource.”SVT

KathyAnnArde,RNAaronDay,RN

Fromleft,AaronDay,RN,AlanJasper,MD,BrianKahn,MD,FayeMontegrande,MD,andKathyAnnArde,RNdiscussthedocumentationofapatient’scondition.

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Poweredbyfederalincentivesandregulatorypressures,thewindsofchangeareblowingawaythepapercharts.Implementationofanelectronicmedicalrecordssystemisoccurringatasteadypaceatcommunity-basedphysicianofficesandSVMChospital-basedclinics.

RonaldShigematsu,MDandSumiKawaratani,MD,whoshareafamilypracticeinLittleTokyo,havepavedapathtoapaperlessoffice,achieved“meaningfuluse”oftheircertifiedEMRsystem,andeachreceived$18,000infederalstimuluspayoutsthispastJanuary.

Thefinancialincentivesarenottheonlybenefit.Theyshouldbeabletosecuregoodphysicianprofilesbecausehealthplansaregoingtoratephysiciansbasedinpartonmeaningfuluse.

Drs.KawarataniandShigematsuarethefirsttoreceivethestimuluspayments“forusingEMReffectivelyandefficiently,”accordingtoDaughtersofCharityHealthSystem(DCHS)PhysicianEMRProjectConsultantLoriMoore.Shesaidthatotherphysiciansareoncoursetoqualifyfortheirstimulusfundssoon.

Bothphysicianstransitionedtothe“tablet”portablecomputerinJune2011forchartingandprescriptionwiththeAllscriptsMyWaysystem.TheyandanotherdozenearlyadoptershavereceivedhospitalsupportforthemeaningfuluseoftheEMRsystem.

“Ithasitsadvantagesanddisadvantages,”saidDr.Kawaratani.“There’sdefinitelyalearningcurveandfinancialinvestment,buttherearealotofpotentialbenefits.”

DuringthetransitiontoEMR,thereisopportunitycostintermsoftimethatmightotherwisebespentwithmorepatients,accordingtoDr.Kawaratani.However,she’senthusiasticaboutthefuturefunctionalityofthesystemthatcanbeexpectedtospeedupthechartingprocess.

DCHSPhysicianEMRConsultantRebeccaGraysonaddedthattheachievementofmeaningfuluseissomethingworthcelebrating.It’sespeciallyimportantinpracticeswherephysicianstreatchronicallyillpatients.

“MeaningfuluseofEMRfocusesontreatmentofpopulations,howyouprovidestandardofcareforpatientswithdiabetes,cardiacproblems,highbloodpressure,osteoarthritis,”saidRebecca.“Thetrackingthattheyhavedone,inordertoearnthestimuluspayments,showsthattheyhaveachievedmeaningfuluseandprovidedthatcaretotheirpatients.”

WiththecomingofanintegratedEMRphysicianorderentrysystemhospitalwide–anticipatedtotakeplacewithinthiscalendaryear–therewillbeworkstationsonwheelsontheunitsthatwillhelpbringtogetherphysicianordersandelectronicchartingbyrespiratorytherapists,chaplains,dietitiansandothercareproviders.

MelindaCanny,directorofITforSVMC,whohasimplementedEMRsystemsfortwohospital-basedclinicssofar,willbeworkingwithateamtorolloutanintegratedsystemthroughoutthehospital.

“We’relookingathowpeopledotheirjobs,howEMRwillchangetheworkflow,andthemostefficientwaytousecomputersystemsthatwealreadyhave,”saidMelinda.

Thereismuchthatearlyadoptersinthecommunitycanteach.Exceptforwritingprescriptionsforcontrolledsubstances,whichmustbedoneonpaper,Dr.

Shigematsuusesthetabletforallcharting.Hetakeshiscomputertablethomewithhim,haslearnedhowtouseitsmainfunctionalities,andalsolearnedhowtointroducethenoveltyofthetabletintohispatientinteractions.

“PatientsmadefunofmeatfirstwhenIwalkedinwithatablet,butnowthey’reusedtoit.It’snotslowingmedown,”saidDr.Shigematsu.SVT

Fromleft,RonaldShigematsu,MDandSumiKawaratani,MDshowofftheirtabletPCsthattheyuseinchartingalltheirpatientrecords.Theirofficeistruly“paperless.”Thepaperchartsinthebackgroundareusefulforreference.

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C D I E f f o r t H e l p s P h y s i c i a n s M a s t e r N e w Vo c a b u l a r y

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Mercedes “Mercy” StineyHIM

Vincentian Spirit Award WinnerOctober 2011

MercyStineyworksintheHIMDepartmentandtakesexcellentcareofphysicians,patients,andcolleagueswhoneedinformation.Shegoesoutofherwaytoanswereveryone’squeries.Shepatientlytrainsotherco-workersintheresponsiblemethodsforworkingwithmedicalrecords.SVT

ShawnMuleadyhasworkedfortheDaughtersofCharityHealthSystemfor10yearsandmovedfromSetonMedicalCentertoSVMCmorethanayearago.HeisclinicalcoordinatorforTelemetry,AcuteRehabandTCU,workingonscheduling,Kronostime-keeping,andequipment.Hefindsthetimetoassistvisitorstotheirdestinationsandmaintainapositiveattitudewitheveryonehemeets.SVT

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Shawn MuleadyTelemetry, ARU and TCU

Vincentian Spirit Award WinnerNovember 2011

VincentianSpiritAwardawards

Adaia “Lupe” SanchezMulti-Organ Transplant Center

December 2011

Adaia“Lupe”SanchezworksastheregistrationreceptionistattheMulti-OrganTransplantCenter.Sheistheonewhogreetspatientskindlyandrespectfullyoverthetelephone.Shetreatseachpatientwithrespect,honesty,andcompassionandgiveseachoneindividualattention.Lupealsohelpswiththesupportgroups.SVT

Maureen Leyran, RNDoheny ICU

January 2012

MaureenLeyranexemplifiestheVincentianSpiritinherworkwithherpatients,theirfamiliesandassociates.BeforeshewouldattendherVincentianSpiritAwardreception,shemadesurethepatientshadcoverage.Whatafineexampleofbeingpatient-focused.CongratulationsMaureen!SVT

Mario PalaciosO.R. – Patient Attendant

February 2012

Marioalwaysarrivestoworkontime;greetseverypersonhemeetswithasmileandpositiveattitude.Hetakesprideintheservicesheprovides,showscompassionandrespecttopatientsandtheirfamilies,anticipatestheirneedsandtheneedsoffellowassociates.MarioembodiestheVincentianValues.SVT

MaryLouYapp(frontmiddle)earnsthePrideoftheCCUAwardlastSeptember.

PrideoftheCCUAwards

ElsieBermudez(thirdfromleft)receivesthePrideoftheCCUAwardonJan.26.

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PatientsGiveGiftsinRecognitionofGuardianAngels

Sr.CeciliaNguyen,DCreceivesGuardianAngelrecognitiononNov.28,2011.

HarlanC.Amstutz,MD,foundingdirectoroftheJointReplace-mentInstitute,receivesGuardianAngelrecognitiononJan.30.

Fromleft,MaryAnneHattemercongratulatesChiquiVillaromanandHildegardeParaiso,bothregisterednursesintheDICU.JanStein,VP,executivedirectoroftheSt.VincentFoundation,presentstheirGuardianAngelrecognitiononFeb.14,2012.

DinoLaurenBautistaoftheE.D.(middle)receivesthefourthDAISYAwardonJan.5.

NeurosurgeonFardadMobin,MD,FAANS,atthenewSt.VincentSpineInstitute,washonoredFeb.10byapatientwhosaidshehadbackpainfor10years,butwaitedtofindtherightsurgeonattherightinstitution.

GeneralsurgeonCarlosCosenza,MDreceivesGuardianAngelrecognitiononFeb.22,presentedbyDougKleam,COO(center)andJanStein,VP,executivedirectoroftheSt.VincentFoundation.

NeurotologistDeraldBrackmann,MD,co-principalinvestigatorfortheauditorybrainstemimplantatHouseClinic,receivesGuardianAngelrecognitiononMarch1.

SVMCisoneofonly20hospitalstoearnQualityRespiratoryCareRecognitionfor2012,oneofonlyfourhospitalsoutof70inLosAngelesCounty.TheRespiratoryCareProgramteamcelebrates.

RespiratoryCareAwardDAISYAward

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PuttingourpatientsfirstisnothingnewatSt.VincentMedicalCenter.Butnursesmakingroundseveryhour,proactivelyaddressingpatientneeds,isnew.Andit’sawinforbothpatientsandnurses.“Consistentprocessandcommunicationimprovesthepatientexperience,”saidRosanneMaehara,DirectorofTelemetry.“Patientsfeelmoreateasewiththeirhospitalstaywhencareisconsistent,resultinginfewercalllights.”“Oneofthegoalsofhourlyroundingisfornursingtobemoreproactiveratherthanreactiveinmeetingpatientneedsandto

deliverbetterclinicaloutcomes,”explainsKimDeese,CNO.“Everyhourduringtheday(andeverytwohoursatnight),amemberofournursingstaffroundsoneverypatient.”Duringrounding,nursesatSt.VincentMedicalCenterensurethatimportantelementsofcareareaddressedsuchaspaincontrol,bathroomneeds,bodypositioning,andthatnecessaryitemsarewithinreach.HourlyroundingisoneofthecornerstonesofourDCHSpatientexperienceprogramandoneofthesignificantfactorsinourreductionofpatientfalls,accordingtoKimDeese.AccordingtoStuderGroup,researchshowsthatastrategyofconsistentlycheckingonpatientneedseffectivelyreducesmonthlycall-lightuseby38percent,patientfallsby50percent,andskinbreakdownsby14percent,while

simultaneouslyincreasingsatisfactionscores.“I’vealwaysbeeninandoutofmypatients’rooms,butnowI’mmorestructuredandfocusedonengagingmypatient,”saysMoonJeong.“Hourlyroundingdecreasestheiranxietyanddecreasesourwork.Iamabletoseemyworkthroughmypatient’seyes.”AccordingtoPresident/CEOCathyFickes,“Hourlyroundingcreatesaculturethatemphasizesexceptionalcustomerservice,inadditiontopatientsafetyandqualitycare.Itisn’tjustatask,it’salifesavingpractice.”SVT

pat ient experience

2131W.3rdSt.LosAngeles,CA90057www.StVincentMedicalCenter.comwww.facebook.com/stvincentmedicalcenter

Pain ManagementInternal MedicinePhysical MedicineAnesthesiologyOrthopaedic Surgery Orthopaedic SurgeryOrthopaedic Surgery

Welcome New Physic ians Sheldon Cho, MD

Azmy F. Ghaly, MDMaqbool Iffat, MDMichael Kim, MD

Jan Duncan, MDLuigi Galloni, MD John J. Regan, MD

MoonJeong,RNroundsonherpatienteveryhour.

H o u r l y R o u n d i n g : A Pr o a c t i v e A p p r o a c h

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