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18 August 2015

Improving Newborn Hearing Screening Programs

Thanks to a combination of policy and technology, newborn infant hearing screening programs have made tremendous progress over the past two decades. Policy changes — spearheaded by position statements from the NIH (1993) and Joint Commission for Infant Hearing (JCIH, 1994) and later supported by the American Academy of Pediatrics — drove meaningful discussion about the importance of early detection of hearing deficiencies, while advances in Automated Auditory Brainstem Response (A-ABR) technology made it possible to efficiently screen all newborns within 12 hours of birth. As a result, more than 97 percent of all U.S. newborns now receive a hearing screen before discharge from the hospital.

Because hearing loss is the most common congenital condition in the United States, this change has had a major positive impact on public health. The system is not yet perfect, though. Just as with any new process, these changes have introduced complexity to neonatal programs, and this complexity must be managed properly to extract the maximum benefit.

Because the hearing screen process is relatively routine and low-skill, the primary challenge for hospital management is less about process optimization than it is about staffing and training. Most staff issues can be traced to two related problems:

Poor Knowledge of Local EHDI Program

As part of the push to improve early hearing screening policy, the CDC set aside grants to support the development of Early Hearing Detection and Intervention (EHDI) programs at the state-level. While this provided states with additional flexibility to meet the national EHDI goals, it also led to the development of dozens of parallel processes for achieving the same result. Each state has its own ways of implementing EHDI programs and mandating continuing education for medical employees, and the quality of these implementations can vary widely.

This makes dealing with staffing issues and policy changes more challenging, for obvious reasons. Without a national standard (or high quality state-level one), hospitals can struggle to recruit staff that have the necessary skills to immediately contribute to the productivity of the screening program. This puts a significant burden on the hospital's human resources team.

Improper Training on Hospital SOPs

Staff that lack proper state-level EHDI training will naturally struggle with hospital-level standard operating procedures (SOPs). This case is surprisingly common: at some hospitals, many staff are unaware that their state even offers an EHDI program. When training is absent and these SOPs are poorly implemented, it creates “loss to follow-up,” “loss to documentation” and “loss to treatment” cases. These are essentially scenarios where process errors allow newborns who failed their screening to slip through the cracks and not receive appropriate follow-up care. According to the American Academy of Pediatrics, almost half the children who do not pass their screening ultimately fall through the cracks and do not receive a documented diagnosis.

Solutions

There are many strategies for addressing these issues, but at their core they all share three things: a comprehensive knowledge of EHDI programs, a solid recruitment pipeline and a well-documented training and SOP library. While it is certainly an option for a hospital to develop these resources in-house, the majority find that partnering with a physician services organization is a more cost-effective solution. Unlike individual hospitals, physician services groups can apply scale to hearing screening programs, which means that staff pipelines are more robust and best practices can be implemented quickly across an entire network. In addition to these management practices, the scale offered by external groups allows them to easily implement best-in-class technologies, including pre-existing billing systems that simplify payment. In most cases, this leads to improved department performance at a lower cost when compared to an in-house solution.

If you're interested in learning more about how Sheridan can help make your hospital's hearing screen program as successful as possible, we encourage you to visit our Healthy Hearing website or contact us directly.

24 July 2015

21st Century Medicine – Leveraging the Benefits of Distributed Radiology Solutions

When it comes to technological advances changing the way healthcare is delivered, no specialty has undergone more drastic changes than radiology. The advent of distributed radiology — driven by the ability to reliably transmit radiologic studies via Radiology Enterprise Management (REM) systems— has led to significant improvements in patient care, increased physician satisfaction and generated cost savings for hospitals. Gone are the days when a radiologist needed to be physically on site to read and interpret an image in order to make a diagnosis; REM systems have given both radiologists and radiology departments increased flexibility in how they deliver their services. As a result, the distributed radiology market is large and growing; valued at $920 million in 2012, it is expected to grow to $3.78 billion by 2019.

Distributed radiology benefits the healthcare industry in numerous ways: first, it benefits the patient by providing doctors and hospitals with a more comprehensive set of tools to come to a complete, precise diagnosis at any time of day; second, it benefits radiologists by making their employment conditions, working arrangements and hours more flexible; and finally, it benefits hospitals by giving them flexibility in their staffing models so that they may adapt to shifting demands in their local market.

Let's begin with patients. Advances in technology now allow hospitals to provide comprehensive and quality service to their patients 24/7. Even after hours, emergency room doctors can send studies to the overnight radiologist in his or her home office and get a diagnosis back in near real-time. Before distributed radiology, after-hours reads may not have been possible, thus limiting the quality of care that a provider could achieve. Furthermore, enterprise radiology systems can provide remote access to subspecialists, whose additional expertise lends itself to greater diagnostic accuracy (when compared to generalists).

Radiologists also benefit from this arrangement, enjoying increased flexibility with their schedules and work environments. Radiologists can choose to work from their home offices or take night shifts in order to have time during the day to spend with their family or address other personal needs. Allowing flexibility in their schedules is an important factor in physician satisfaction and retention rates. Additionally, highly specialized radiologists can now apply their expertise to cases outside of their local area, which improves both their career and the outcomes of the patients they serve.

Distributed radiology also allows remote radiologists to access all of the information they need – including prior studies – in real-time, which significantly improves diagnostic accuracy in cases where a radiologist needs more information than simply the most recent image of a patient. This has obvious impacts on quality of care and is especially useful in geriatric and/or high-acuity cases.

Finally, distributed radiology solutions also provide hospitals with cost-saving opportunities by giving their staffing model more flexibility. By connecting in-house radiologists with specialists anywhere in the country at any time of day, distributed radiology gives hospitals the flexibility to hire radiologists on a per-case basis and rapidly respond to variations in patient volume.

If you're interested in learning more about how Sheridan helps implement distributed radiology solutions for radiology departments across the country, we encourage you to contact Sheridan’s radiology experts today.

16 July 2015

Sheridan Physicians Help Memorial Regional Hospital Win Prestigious STS Ranking

When Sheridan partners with a hospital, we don't just staff a department — we partner with management to build a culture of innovation and continuous improvement, striving to make that department the best it can possibly be. Our clinical leaders embody that ideal, and three of our physicians recently demonstrated a fantastic example of just that: Dr. Joseph Loskove, our regional medical director, Sheridan anesthesiologist Dr. Robert Brooker, and Dr. Adam Blomberg, the national education director for the anesthesiology division of Sheridan.

Dr. Loskove serves as the chief of anesthesia for the Memorial Healthcare System in South Florida; Dr. Brooker is the chief of cardiac anesthesia at the healthcare system’s flagship hospital, Memorial Regional Hospital in Hollywood, Fla.; and Dr. Blomberg is the chief of anesthesia at Memorial Regional. The three physician leaders made it possible for the hospital's cardiac surgery program to achieve an across-the-board 3-star rating from the Society for Thoracic Surgeons (STS).

A complete 3-star rating from the STS is very difficult to achieve — only 1.2 percent of the 1,005 surgical sites surveyed this year were able to win the distinction. To be recognized, facilities must demonstrate excellence in three procedures: coronary artery bypass surgery (CABG), aortic valve replacement (AVR) and combined CABG/AVR. As leaders of the anesthesia group at Memorial, Dr. Loskove, Dr. Brooker and Dr. Blomberg played key roles in making this achievement possible.

Dr. Richard Perryman, the medical director of Memorial Regional's Cardiac and Vascular Institute, highlighted the importance of his collaboration with the cardiac anesthesiologists in an announcement to hospital staff. Specifically, Dr. Perry recognized the “tremendous contribution of the cardiac anesthesia group to these outstanding results,” and said that “their continuing skills, dedication and enthusiasm” played a critical role in developing the “most comprehensive and high-quality service line for all patients needing cardiac care in South Florida.”

Building “the most comprehensive and high-quality service line” in South Florida — that's a mission that Sheridan is proud to be a part of. Congratulations to Dr. Loskove, Dr. Brooker, Dr. Blomberg and their team — we look forward to more fantastic results from MRH!

8 July 2015

Gulf Coast Regional Medical Center Introduces Neonatal Cooling Therapy

Sheridan would like to announce that the NICU team at Gulf Coast Medical Center in Panama City, Florida has begun neonatal cooling therapy, thanks to the efforts of neonatologist Melissa Tyree, MD, FAAP. Dr. Tyree and this new therapy were highlighted on local channel 13 WMBB-TV: “This therapeutic option is being provided to term and near-term infants who experience birth-related oxygen deprivation and show signs of brain injury. The therapy has been shown to reduce the risk of death and disabilities such as cerebral palsy, mental retardation, and learning disorders.”  There are several problems that occur during pregnancy and delivery that can lead to this condition, also known as Hypoxic Ischemic Encephalopathy (HIE). Therapeutic cooling is a clinical treatment that involves reducing a patient’s body temperature to 92 degrees Fahrenheit for three days. In the past there was no brain-specific therapy for HIE. While cooling therapy is safe and effective, it must be initiated within 6 hours from birth. Cooling therapy also requires close monitoring and management of potential side effects and therefore can only be performed in selective, experienced level 3 neonatal intensive care units.

Click here to view the full video

Shortly after the development of the level 3 neonatal intensive care unit at Gulf Coast Regional Medical Center, the neonatologists and neonatal care team worked diligently to develop a Neonatal Therapeutic Hypothermia (Cooling) Program.  On March 1, 2015 the program was officially opened. On April 1, 2015 the first patient requiring therapy was born and experienced a full recovery with a normal exam and normal MRI after completing the 72 hour therapy. Her parents' gratitude was beyond words; not only for her recovery, but also for the ability to remain at her side throughout her entire hospital course now that this new therapy is available at Gulf Coast Regional Medical Center.

This is an exciting program that will permit timely therapy for infants born at GCRMC.  It will also provide a closer transport alternative than Pensacola or Tallahassee for babies born at other hospitals in the Florida panhandle.

1 June 2015

Strengthening Emergency Department Intake Processes

There are many measures of hospital quality, but two primary dimensions that stand out are patient health outcomes and operational efficiency. Though sometimes they seem to be at odds, the best hospital process improvements tackle these dimensions simultaneously.

Emergency department personnel are uniquely positioned to understand the relationship between patient care and efficiency — they treat both high acuity and high volume patient segments, and they’re largely measured by door-to-provider time and throughput. In the emergency department, improvements to intake and triage systems can have positive impacts on both patient outcomes and the operational efficiency of the department.

Example: Parallel Care Model of Patient Assessment

Slow door-to-provider times are a strong indicator of inefficiency in the ER — and a patient safety risk. Employing Kaizen lean process techniques, Dr. Ken Colaric of Sheridan partner hospital Saint Mary’s Medical Center in Missouri worked with his team to identify areas of inefficiency in their existing triage system. The Kaizen analysis and conversations with all stakeholders resulted in an entirely new “parallel care” model of patient assessment.

The parallel care model encourages emergency department personnel to attend to a patient as soon as they are available, rather than having providers wait for their proper turn in the traditional sequence of emergency care. The department also instituted immediate bedding, so that the patient is ready for a nurse, physician or tech to begin their work as soon as they are available to do so. Registration happens bedside, dramatically cutting down waiting room time.

Saint Mary’s new parallel care model and bedside registration have improved nearly every metric of success for the department. Patients’ average length of stay has been reduced by 30 percent. The “left before being seen” rate dropped a dramatic 88 percent. Door-to-bed and door-to-doctor times have seen significant decreases as well.

In many hospitals, 60-80 percent of inpatient admissions are made in the ER. With the majority of a hospital’s patients experiencing emergency care — and with CMS reimbursement now tied to patient satisfaction — the ER experience has never been more important. Identifying emergency department process improvements that benefit patients’ health outcomes, throughput and, by extension, patient satisfaction, is how hospital leaders can best drive lasting change in their ER.

To learn more about the ways Sheridan Healthcare can help strengthen your emergency department’s processes, read our leadership brief: “The Evolving Emergency Department: Strategies for Staying Ahead of the Curve.”

19 May 2015

Physician Engagement is a Win, Win, Win

The term “physician engagement” is ubiquitous in today’s healthcare conversation, and it is often prescribed as the solution to a number of hospital management issues. But what does it really mean, and why is it so beneficial?

Achieving Engagement

To be engaged means “to be greatly interested or committed.” Physician engagement centers on a physician’s commitment to enhancing the performance of the organization by continuing to develop their own clinical and managerial skills, as well as those of their teammates.

When physicians are engaged, they are actively involved in their organizations – they go beyond treating their patients and performing the accompanying administrative duties. Engaged physicians participate in and lead education courses; they also serve on boards and committees within or on behalf of their organization. They dedicate their time and effort to the larger goals of the hospital or health system, beyond their immediate goals as individual physicians.

There is much discussion about how hospital leaders can achieve physician engagement. At its core, the process is similar to creating a successful business relationship: hospital leaders must establish mutual trust, empower physicians to voice their opinions, involve physicians in crucial decision-making processes, and ensure they have the access to the resources they need.

Benefits of Engaged Physicians

The benefit to having engaged physicians is three-fold: happier physicians, healthier patients and a better performing hospital.

Not only do physicians themselves benefit from being engaged, but so do their patients. Engaged physicians demonstrate a deeper commitment to improving their own performance. One important aspect of a physician’s performance is demonstrating empathy. Patients with empathetic physicians are more likely to confide personal details that may help in diagnoses, and are more willing to adhere to treatments that improve their health. Recent studies have shown that a positive doctor-patient relationship can actually improve outcomes for patients with obesity, diabetes and asthma. Additionally, patients of engaged, empathetic physicians are more likely to be satisfied with the care they have received.

With more hospital reimbursement tied to patient satisfaction and health outcomes, hospitals will benefit enormously from an engaged physician group and the improved patient outcomes that come along with it. Not only are patients happier and healthier, but when physicians are engaged, they think about the goals of the organization at large. Therefore, change management and process improvement initiatives have a higher likelihood of succeeding in hospitals with engaged physicians.

Physician engagement may indeed be one key to hospital performance improvement on a number of different levels. It is important to spend time thinking about what engagement really means before developing a strategy to cultivate it.

To learn more about how hospitals can engage physicians and align the goals of the organization and the individual, check out our white paper: Advancing Hospital-Physician Collaboration with a Clinical and Management Services Organization.

24 April 2015

Joe DiMaggio Children’s Hospital Institutes “Tutu Tuesday”

Thorough audits that involve all staff equally are the best way to improve hospital processes. But while these rigorous process improvement frameworks are at the core of what we do, we also realize that good ideas often come from less structured origins.

One of our partner hospitals, Joe DiMaggio Children's in Hollywood, Fla., reminded us of this when they instituted “Tutu Tuesday.” Joe DiMaggio has a long history of innovation in pediatric surgical care, especially when it comes to patients with autism – but Tutu Tuesday is a little different.

In contrast to their rigorous and well-documented autism procedures, the creation of Tutu Tuesday was a bit more serendipitous. It all started when operating room assistant Tony Smith wanted to make one of his pediatric patients a little less nervous before surgery. To make the preoperative process more light-hearted, Tony decided he'd put on a multi-colored tutu over his scrubs.

The patient loved it, and that simple, silly idea ended up going a long way to improve his experience. Smith never imagined that this small gesture would end up spreading through the department and improving dozens of patients' surgeries – and he certainly didn't foresee that it would catch the attention of the national news media, including ABC News, NBC TODAY and dozens more.

Tutu Tuesday teaches us that, sometimes, process improvements that improve patient experience can come from the most unexpected places – and are almost always a little unorthodox. As Smith told ABC News: “Seeing you in a tutu brightens [patients'] day, and it can keep them from thinking about what's really going on.”

10 April 2015

Blood Management Programs Help Improve Quality and Reduce Costs

Blood transfusions are among the most common medical procedures at US hospitals. In this case, however, more is not always better.

The Need for Blood Management

Blood transfusions are often necessary lifesaving procedures, but hospitals must be careful of overusing transfusions when unnecessary. The inefficient use of blood transfusions is both risky and wasteful. Transfusions bring higher risks of mortality and other dangerous complications. They are also costly. The direct cost of one unit of red blood cells is $200 on average, but there are numerous supplemental costs such as the transportation, testing, inventory management and storage of the blood. A 2010 study published by Transfusion, a peer-reviewed academic journal, estimated that blood transfusion costs actually range from $522 to $1,183 per unit of blood. Additionally, transfusions can impact the length of stay for a patient if infections or complications occur, driving costs up further. If a hospital is not careful in its management of blood transfusions, it can rack up hundreds of thousands of dollars per year of unnecessary added costs.

Characteristics of Effective Blood Management Programs

In today’s value-based, cost-sensitive healthcare market, an effective blood management program can help hospitals lower costs and improve quality of care.

The first component of these programs is the establishment of standardized guidelines that help doctors determine whether a transfusion is necessary or avoidable. National blood transfusion protocols do not exist, so hospitals are responsible for developing and propagating their own guidelines. Necessary guidelines include developing a standard order to transfuse, mandating that transfusion orders be required and documented during all surgeries, setting acceptable pre-transfusion blood lab values and creating a consistent informed consent process for patients that may encounter a transfusion.

Once hospital-wide transfusion guidelines are defined and implemented, applying some of the blood management strategies recommended by the Society of Cardiovascular Anesthesiologists (SCA) and Society of Thoracic Surgeons (STS) can help build out a comprehensive multimodal blood conservation program. Some of those strategies include:

  • Working with cardiologists before surgery to make sure the patient is not on unnecessary doses of blood thinners and to ensure anemic patients have the proper pre-op medicine
  • Carefully rationing IV fluids so the patient’s blood concentration does not drop unnecessarily during surgery
  • Drawing a unit of blood from the patient the day of surgery, in case it is needed
  • Reducing the amount of plumbing in the heart/lung machines so that they use less blood-diluting fluids
  • Standardizing the way anti-bleeding medications are given during surgery

Education is also a critical component of an effective blood management program. Hospital staff need to be fully informed about the risks, benefits and alternatives to transfusions. Education helps doctors and staff achieve a patient-centered decision making model that is integral to quality improvement.

Example of a Successful Blood Management Program

A Sheridan anesthesiologist, Dr. Robert Brooker, initiated a blood conservation program to improve the transfusion rates at Memorial Regional Hospital in South Florida. The hospital started following an established protocol in 2008 and conducted a five-year study of the results of more than 1,000 patients. Over the span of those five years, Memorial Regional Hospital was able to:

  • Reduce surgical transfusions in cardiac patients by 68%
  • Reduce the amount of blood needed by 80%, saving the hospital $715.14 per unit
  • Reduce the number of heart surgery-related deaths, infections, strokes and re-operations by 50%
  • Reduce infections by 100%

These reductions have helped earn Memorial Regional Hospital its current 3-star rating from the Society of Thoracic Surgeons (STS), the highest rating awarded by the organization.

Conclusion

Transfusions will always be necessary on some level. A blood management program is not aimed to reduce these procedures across the board, but rather to target where transfusions may be unnecessary and might actually be putting patients at risk. As Dr. Brooker explained, “Blood transfusions in heart surgery, or anywhere, are only good for you if you really need it.”

26 March 2015

Aligning the Board Room and the Operating Room

At its core, leadership is about helping a group of people with diverse skillsets and perspectives work together effectively. Generally, a team with a broader collective skillset is able to produce more valuable products and services than a more homogenous team. However, the realization of that added value almost always hinges on a leader’s ability to focus the team members’ diverse perspectives on a common goal. The more divergent perspectives a leader can align, the more value he or she can create; put simply, more difficult challenges yield greater rewards.

This concept was highlighted in a recent piece in the New York Times’ The Upshot column, titled “In Hospitals, Board Rooms Are as Important as Operating Rooms.” In the article, health economist and researcher Austin Frakt makes the case that the most significant hospital process improvements won’t come from a clinical team alone; instead, they develop by aligning the goals of the clinical and business leaders within a hospital. As the primary intersection between clinical leaders and the board of directors, CEOs and other senior leaders are uniquely positioned to bring about that alignment.

For obvious reasons, this is easier said than done. Besides the overall success of the hospital, clinical leaders and board members have few priorities in common. Boards, for the most part, are primarily interested in the facility’s financial health, and many members have little experience with the intricacies of the healthcare industry. Clinical leaders, on the other hand, are focused on the efficiency of the departments they oversee and the care and satisfaction of their patients. These issues are two sides of the same coin – an insolvent facility can’t function, and the link between reimbursement and patient satisfaction means quality of care directly affects the bottom line. The hallmark of a good leader is the ability to bridge this gap.

This means improving communication between the two teams, and – as the New York Times article makes clear – one of the best ways to do so is by borrowing management practices from the manufacturing and technology sectors. One of their most successful management practices is Kaizen, which Sheridan Healthcare has been helping hospital leaders implement for decades. Kaizen is particularly useful for improving communication between parties with different perspectives. As the article puts it:

“These management practices include eliminating inefficiencies and variations, fostering collaboration, setting targets and tracking progress toward them.“

Kaizen encourages a continuous stream of feedback from all stakeholders in a particular process. It helps eliminate waste from a process while ensuring the resulting improved process meets the needs and goals of everyone involved. The Times article highlights instances of Kaizen and other “lean” management techniques

reduc[ing] the time it takes between when a heart attack patient arrives at a hospital and when he’s treated, improving outcomes. Other work found good management is associated with better quality of care in intensive care units.”

Through a management technique like Kaizen, hospital CEOs and other leaders can facilitate the creation of streamlined hospital processes that meet the goals of physicians and other care providers, as well as the C-suite and board. This alignment of diverse skillsets and perspectives drives clinical, financial and organizational improvements for a hospital, simultaneously.

To learn more about Kaizen and how it’s been successfully implemented in the past, watch our video here.

26 February 2015

Improving Patient Care Through Efficient Processes

In many hospital systems, quality improvement efforts focus primarily on an outcome rather than the process that produces it. This may make sense intuitively, but experience has shown it to be the wrong strategy: in the vast majority of cases, small investments in process improvement can lead to outsize improvements in the final product.

This concept was highlighted in a recent FierceHealthcare guest post by Dr. Tom Scaletta, the Medical Director of Emergency Services at Edward Healthcare in Naperville, Illinois. In the article, Dr. Scaletta explains how a seemingly minor change to his organization’s patient follow-up processes – contacting patients immediately after discharge rather than with a mailer several days later – translated into significant improvements in patient outcomes and patient satisfaction scores. By contacting patients immediately after discharge, the hospital improved their survey response rate significantly and generated hundreds of “valuable real-time opportunities to improve patient care, reduce readmissions and understand important patient perceptions.”

Although they often sound simple, process improvements can be surprisingly difficult to implement. This is because designing and implementing improved processes requires critical thinking from the entire team, deep understanding how the current process works and buy-in from all affected employees. Overcoming these challenges and unlocking this potential for improvement is a critical function of the modern healthcare executive.

Process Improvement Systems

C-level hospital executives can’t be personally involved in driving improvement in every one of their organization’s processes – there’s simply too much to do. Instead, the executive’s role should be establishing systems that encourage process improvement and building a culture that helps employees find and implement them. This is, arguably, a much more difficult task than simply implementing, but the results are certainly worth it. Achieving the types of process improvements detailed in Dr. Scaletta’s article is much easier when such a system is in place.

Fortunately, management frameworks exist that can help healthcare organizations achieve this goal. One such is Kaizen, a methodology for continuous process improvement that was most famously implemented by Toyota. Kaizen is a powerful framework that helps employees improve and standardize processes, and it excels in clinical settings. The Kaizen approach works especially well with multi-disciplinary teams and allows for rapid implementation of new processes. Furthermore, it encourages a culture of continuous improvement as staff are encouraged to provide feedback through the entirety of a process – before, during, and after its implementation. In a nutshell, Kaizen makes processes more reliable and less wasteful while simultaneously encouraging meaningful employee involvement.

Implementation Challenges

While implementing a new process is hard in any organization, those in the healthcare industry know it is particularly challenging in a clinical setting. Buy-in, particularly among physicians and nurses, is tough to get, yet critical to success. Convening – let alone assigning importance to – opinions is equally challenging, and the energy to carry out the new process can wane over time. But such measures are necessary to develop and implement a process that works for patients and the systems in which they are treated.

As healthcare organizations look to improve processes facility-wide, it’s critical to remember the importance of a solid process improvement framework such as Kaizen. In addition to improving culture, these frameworks have been shown deliver a remarkable return on investment for the organizations that implement them. As the healthcare landscape continues to change – be it towards patient-focused care or another front – process improvement frameworks will help ensure that the industry evolves with it.

To learn more about how the Kaizen approach can improve hospital processes, visit our resource center.