Holston Medical Group program makes patient safety top priority

Rick Wagner • Oct 18, 2008 at 12:00 AM

Patient Joan Peters talks with Dr. Eric Schwartz during a recent visit. Peters suffers from congestive heart failure and is one of the patients being cared for as part of the Academy of Patient Safety at Holston Valley Medical Center. Erica Yoon photo.


KINGSPORT — Every week day at 10:30 a.m. health care professionals hold a meeting to discuss the status of every patient on the fifth floor of Holston Valley Regional Medical Center.

The discussion — known as a multi-disciplinary care meeting or patient care conference — focuses on a patient’s diet, breathing, mental state, mobility, potential discharge dates and response to medications, among other things.

And participating in the up to hour-long meetings are not just doctors. Nurses, nutritionists, respiratory therapists, physical therapists, pharmacists and others are there. Each can address or ask about any problems or issues they see with a particular patient.

It’s called the Academy of Patient Safety, a program of Holston Medical Group and the brainchild of Dr. Eric Schwartz with the help of other HMG physicians called hospitalists.

The academy started May 22, 2005, on the fifth floor of Holston Valley but plans are to expand it to other floors and hospitals, Schwartz said.

Although founded with patient safety foremost in mind, he and HMG’s president and founder, Dr. Jerry Miller, said the academy also is in a prime position to address changes in Medicare reimbursement for hospitals.

As of Oct. 1, Medicare no longer will pay for what it considers preventable conditions such as bed sores. Patients are not held responsible, so the financial loss goes back to the hospital.

Focusing first, foremost on every patient’s safety

Schwartz, director of the academy and head of HMG’s Hospitalists Team, said the first and foremost goal of the academy is to improve patient safety, although intertwined in that are efficiency and family and patient education to avoid re-admissions.

The vision, he said, is to provide the best patient care available.

To that end, he said the heart of the academy is to get input on patient care to doctors from all involved health care providers.

That occurs every morning at the 10:30 conference. It includes two doctors dedicated to that floor, as well as nurses, case managers, physical therapists, respiratory therapists, nutritionists and pharmacists.

The floor is a medical/surgical floor with some post-operative patients.

He said every floor in the hospital and other facilities has a specific focus and that all work to improve patient safety, as do the region’s two dominant health care systems, Wellmont Health System and Mountain States Health Alliance.

“Every patient on the floor is discussed,” Schwartz said. He said all are welcome and encouraged to speak up about a patient issue, whether it’s something like someone who’s not eating as much as they should to a patient who nearly fell out of bed or has signs of dementia.

“This has always been my vision,” Schwartz said.

As an example, he said many patients commonly are elderly and debilitated, often living at home and seen by outpatient doctors.

Miller said the program also includes an emphasis on smoking cessation, exercise and diet.

Miller and Schwartz said instrumental to the process, in addition to the other health care providers involved, are 10 other HMG hospitalists.

Aside from Schwartz, they are Drs. Chris Neglia, Srinivas Ananthula, Radu Boiciuc, Richard Dickson, Shoaib Latef, Stephen Smith, Dena Smith (wife of Stephen Smith), Richard Sohn, Jess Vaughn and Johnny White.

This group of 11 doctors performs as hospitalists at Indian Path Medical Center and medical consultants and hospitalists at Holston Valley.

Schwartz said HMG’s electronic medical records program has helped the academy by sharing patient information. Specifically, he said the academy team is working on an electronic discharge summary. Such a document could take a week to get in a patient’s printed files but would be available the day of discharge electronically.

“It’s the coordination of care and collaboration of care,” Schwartz said.

On the other hand, Miller said the program also works to keep health care professionals directly connected with patients, which was evidenced Wednesday afternoon when Schwartz visited Joan Peters of Gate City in her room.

Peters beamed about Schwartz, saying he “saved” her from problems with congestive heart failure, and she talked and joked with him about his recent wedding photos appearing in the newspaper.

Beverly Horton, clinical leaders on the fifth floor and a registered nurse, said she’s a believer in the three-year-old program.

“I’ve worked on this floor for my whole career, 23 years,” Horton said.

Aside from the meetings, she said nurses and others have no hesitation in talking with the hospitalists about a concern between the daily meetings. In addition, she said the team meets once a week to go over ideas to improve the program.

How Schwartz, academy came to Holston Valley

Miller said Schwartz, who he recruited from New York a decade ago, saw the need for the program and got a good reception from Holston Valley, where the program has developed and matured.

“We are going to copyright this because we want every hospital in the country to have this. We want every medical group in the country to have this,” Miller said. “What it does is focus on the patients.”

Schwartz said his vision is for the program to expand to other hospitals, nursing homes and rehabilitation hospitals.

“We’re in discussion,” Schwartz said of expanding the program to other facilities, adding that as a clinician he wants to see it expand.

HMG is in discussions with Bristol Regional Medical Center, like Holston Valley part of Wellmont, and has interest from Indian Path Medical Center, part of Mountain States, Miller said.

“Indian Path is interested in it. Of course we’ve been talking with Bristol Regional,” Miller said. “I believe it will be in all the hospitals HMG attends by the end of the year and certainly not beyond the first quarter of next year.”

Miller said he hopes to adapt the academy to surgical floors and long-term care facilities.

“We admit approximately 500 patients a month to hospitals,” Miller said.

Nationwide statistics have shown that 90,000 to 100,000 people are killed each year by medical errors, with about 75,000 of those through medication errors and about 6 percent of medical interventions in error.

He said the hospitalist program has worked well in the region and has been embraced by patients and other health care professions.

He said the academy on the fifth floor, which HMG manages for Wellmont, has worked to reduce falls, initiate rapid antibiotics for infection, have quick treatment for heart attack patients and do better monitoring of patients.

As a result, he said falls and cardiac deaths are way down on the fifth floor, while medication errors are almost nonexistent, and stays are shorter.

Miller said the hospitalist program gives general practitioners more time to spend on their outpatient work and lets the hospitalists concentrate on hospital patients.

Other patient safety efforts ongoing in region

Schwartz said that most all hospitals and their staffs work toward better patient safety.

For instance, MSHA spokesman James Watson said MSHA and its facilities, including Indian Path and Johnson City Medical Center, participate in the Premier Safety Institute.

Also, the Northeast Tennessee Technology Council recognized patient safety initiatives on Friday during its annual TechStar Awards, held in Johnson City. MSHA won for the development of new technology called “POPS” or Physician On-Call Paging System. It was developed in-house to improve the clinical staff work environment. Among its benefits: increased patient safety by getting the right physician at the right time.

Another TechStar winner was Wellmont for Application of Technology Within a Large Business for its Admin-Rx, an integrated medication bar coding solution for medication distribution. Admin-Rx, is an add-on module to the McKesson Horizon Clinicals system used at Wellmont. The module helps nurses comply with medication distribution patient safety goals. It minimizes the potential for medication errors by requiring nurses to scan the patient’s arm band, then scan the medication bar code, then the patient’s arm again.

Wellmont also has been at the forefront of safety issues through the work of Dr. Richard Salluzzo, former president and chief executive officer, who founded the Safest Hospital Alliance while at Wellmont.

The region also is home to CareSpark, an electronic medical records program or regional health information organization working with other such programs nationwide to make patient medical information accessible at the click of a mouse to medical professionals and, eventually, patients.

CareSpark won a TechStar award for Use of Technology by a Non-Profit Agency and HMG won for Use of Internet or Web Technologies for its electronic medical records.

Medicare rules put new urgency on patient safety

Even with these efforts, patient safety at hospitals took on a new financial urgency with the “Do-Not-Pay” rule of Medicare.

Schwartz said the Medicare changes were not considered or known about when he got the academy started more than three years ago.

“Clearly, Medicare will not compensate institutions for preventable conditions,” Schwartz said.

“The environment is ripe for the process,” Schwartz said. “It’s just fortunate Medicare is thinking along the same lines.”

He said those include but are not limited to:

• Urinary tract infections caused by Foley catheters.

• Bed sores caused by prolonged laying in bed in the same position.

• Hospital-caused urinary tract infections.

• Surgical site infections.

• Deep vein thrombosis, blood clots caused by extended periods of immobility and treated with anti-coagulation medication or leg compresses.

Schwartz said that nursing homes aren’t yet affected by Medicare’s preventable condition rule, but he said it’s only a matter of time before that occurs.

That’s why he said the time is right for nursing homes and other such facilities have the academy or something like it.

Although he said the academy requires some start-up funding and time from staff, he said the financial savings from having better patient safety should more than make up for that financial cost.

As HMG works to copyright the academy and make it available nationwide and make specialized versions, Miller said he is heartened by the response to Holston Valley nurses to the academy.

“We’ve got nurses all over the hospital wanting to come to work on that (fifth) floor,” Miller said, adding that nurse retention is high on that floor.

He and Schwartz said other health care providers, patients and their friends and families respond well to the program.

For more information on the academy, go to the HMG Web site at www.holstonmedicalgroup.com and click on the “read more” link under the “Leading in Patient Safety” heading.

For more information on Wellmont and MSHA, go to www.wellmont.org and www.msha.com, respectively.

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