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Sunday, February 5, 2023

Great isn’t Good Enough

Evansville already has nationally ranked hospitals: Deaconess has earned a Solucient 100 Top Hospitals award for cardiac and orthopedic services and a US News and World Report Best Hospitals ranking for hormonal disease services, while St. Mary’s has achieved ranking for fastest heart attack care and a Magnet designation for nursing, which only 6.74 percent of registered hospitals nationwide have achieved. More importantly, neither hospital is completely satisfied and both are planning to offer updates that address technology, patient rooms, obesity, and readmission rates.

St. Mary’s is scheduled to complete their emergency department (ED) expansion project later this year. The project adds 16 beds and a CT scan to the emergency room (ER). While the main focus of the project is the ER, it also will affect general patients, providing more private rooms and space for treatment, according to St. Mary’s Media Relations Coordinator Laura Forbes. A major service target for 2012 is to reduce readmission rates. Janet Raisor, executive director of case management, community outreach, and rehabilitation, says this is a goal for many hospitals nationally. Minimizing the need to return to the hospital is not only better for the patients’ health; it also reduces health care costs. Raisor says Medicare spends approximately $17 billion annually on readmissions (one out of every five Medicare patients is readmitted within 30 days of discharge), and beginning this year, hospitals will be issued financial penalties for readmissions.

St. Mary’s is urging its doctors and nurses to take basic steps to avoid readmission, such as early discharge planning and understanding patient barriers to home recovery (mobility, finances, and cognition). These actions help prevent common mistakes that could lead to relapse — taking medications incorrectly, failing to follow up with a primary care physician, not knowing symptoms that might indicate a need to return to the doctor.

In this effort, St. Mary’s is encouraging their doctors and nurses to use the “teach-back” methodology, where the caregiver who explains the discharge program to the patient asks the patient to explain it back to them, to avoid misunderstanding and to internalize the information. The teach-back method also addresses any recovery issues the patient might face at home. It’s a time for the patient to ask questions, and for the health professional and the patient to have a discussion. The goal is eventually for all St. Mary’s doctors and nurses to use the program.

As another part of the readmission-reduction initiative, St. Mary’s began a courtesy prescription delivery service during summer 2011, which brings a patient’s first set of prescriptions to his or her bedside to assist with the transition from the hospital. Geriatric and family practitioners, David and Evelyn Bose have recently committed themselves exclusively to their post-acute care model, in which all of their approximately 500 patients are nursing home residents. The couple essentially are traveling doctors with no in-office practice.[pagebreak]Additionally, the hospital launched the St. Mary’s avoidable readmission team (S.M.A.R.T.), which strives to replicate successful national and in-house programs. (The cardiac care transition team performed similar work before S.M.A.R.T. began, as an avenue for reaching out to what soon will be all patients.) S.M.A.R.T. consists of approximately 20 volunteers, including retired nurses and one retired social worker who since July have collectively logged more than 1,000 hours calling patients who have gone home. During these phone calls, the volunteers talk to patients about their medication, therapy, diet, and other aspects of after-care. They can pinpoint reasons why patients aren’t doing what is required for recovery and determine plans that work for them, such as visiting the more affordable ECHO Clinic, with which St. Mary’s has a partnership. They have made more than 6,000 phone calls and more than 200 “catches”— cases where the patient would likely have been readmitted had S.M.A.R.T. not made contact. When a S.M.A.R.T. volunteer determines a patient is struggling with recovery, the St. Mary’s case management team intervenes. This effort creates smooth transitions and prevents readmissions.

S.M.A.R.T. also contributes to the future of medical care in the community. Since January, the program has taken on about 25 nursing and social work students, mostly from the University of Southern Indiana and one from Western Kentucky University, as interns. These interns, by doing the same work as the volunteers, learn about patient recovery and the importance of a smooth transition home. They primarily ask questions and collect information, and it’s through this process that Raisor says they are learning.

In November 2009, Deaconess partnered with an electronic health record (EHR — also called electronic medical record, or EMR) system called Epic and now has implemented the system at their main campus, Deaconess Gateway and Heart Hospital, and Deaconess Cross Pointe. Epic is a paperless system that in December 2011 was awarded Stage 7, the highest national ranking from HIMSS Analytics. (Of 5,000 hospitals, Deaconess is among the top 65 who received this honor.) Public Relations Manager Sam Rogers explains that this system benefits patients because it is efficient and requires them only to enter their information once — the records then “follow” them to any medical caregiver they visit.

Of the Stage 7 ranking, Todd Richardson, chief information officer at Deaconess Health System says, “While it’s a great achievement, it is not the finish line for us. Our focus from day one, when we launched our EMR initiative, was centered on the quality of care for the patients we serve.”

This summer will see a facility upgrade to Deaconess unit 4800, which will become a 24-bed universal intensive care unit (ICU), replacing two smaller ICUs on the Deaconess main campus. Universal beds allow patients to enter the unit in critical condition and be discharged from the same unit, staying in the same bed, in the same location, as the level of care around him or her changes appropriately, minimizing movement and promoting optimal recovery.

Further, Deaconess addressed 2011’s disappointing Gallup poll statistic that called Evansville the most obese city in America by helping to host “Supersize vs. Superskinny,” an English reality television show. “Supersize vs. Superskinny” follows two individuals, one extremely overweight and the other very underweight, as they swap diets, to examine their individual relationships with food. When the show’s creators wanted to cross the pond to study America’s obesity epidemic, Evansville was a natural choice. Deaconess chose to participate, Rogers says, because “shedding light on the problem is always a good thing.”

When the “Supersize vs. Superskinny” team came to Evansville in January, they documented how Deaconess accommodates obese patients with lift systems and bigger wheelchairs, beds, and bathrooms (to name a few). They even interviewed patients and stepped into the community to examine why obesity may be such an issue. Ultimately, their goal was to take a holistic view of how obesity impacts healthcare and the community. Rogers says it’s important to Deaconess to highlight the problems of obesity and see how lifestyles can change in the community so that healthier decisions can be made.
The show begins airing on Feb. 28 in England and may be available for online viewing. One quarter of each one-hour episode will be about Evansville.

With newly implemented systems and ambitious goals propelling them into the new year, Evansville’s hospitals eagerly are serving the community with top-notch technology and methodology and a commitment to helping citizens achieve and maintain healthy lifestyles.

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