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If you are at a Texas Health computer, please scroll down to see the full stories. Otherwise, click the "Learn More" links in the newsletter to advance to those stories.
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"Condition H" program implemented systemwide
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Color-coded wristbands enhance patient safety
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Treatment, transport of remote STEMI patients discussed
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Taking "SMART" approach to improving patient care
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Breast Center continually
helps women
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Experts from Duke University Medical Center, which pioneered many of the national standards for efficiently transporting STEMI (ST-elevation myocardial infarction) patients from outlying hospitals to major medical centers, shared their insights with Texas Health Dallas and Texas Health Kaufman.
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A 64-week project focusing on enhancing patient care delivery systems and metrics management is underway at Texas Health Presbyterian Hospital Plano. The idea is to improve communication amongst various groups.
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An increase in volume for one Women's Services department at Texas Health Presbyterian Hospital Allen is a sign that females in the surrounding communities are heeding to the message of being proactive when fighting breast cancer.
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Texas Health Dallas implements physician hotline
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Intensivists focus attention on critically ill patients
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The HealthCare Improvement Department at Texas Health Presbyterian Hospital Dallas has implemented a 24 hours a day, seven days a week hotline for physicians to share concerns and feedback requiring management follow-up.
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Texas Health Presbyterian Hospital Dallas is one of North Texas' first hospitals to implement an intensivist program, allowing doctors who specialize in working with the most critical patients to be a permanent manager of their care.
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Sonya Merrill, MD, physician on the medical staff at Texas Health Presbyterian Hospital Dallas, received the Texas Health Resources award for Outstanding Community Service by a Physician ... Phil Wentworth, former president of Texas Health Presbyterian Hospital Plano, has been named acting president of Texas Health Dallas ... Last day for Texas Health Dallas President Mark Merrill was May 22 ... Tom Shires, MD, chair of surgical services at Texas Health Dallas, has been voted president-elect of the North Texas Chapter of the American College of Surgeons ... Paul Guttuso, MD, from Texas Health Kaufman was given the honor of being the Texas Physician of the Day on April 14, where he was the physician for the House and Senate.
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"Condition H" patient safety program implemented systemwide
Family members of hospital patients can now alert a designated hospital person or team for immediate help if there are concerns about an emergent change in the patient's medical condition which they do not believe is being addressed by the health care team.
By dialing a designated number at each entity, a family member - or the patient - initiates "Condition H (Help)." This prompts an immediate response by health care professionals who will arrive within minutes to assess the patient's condition.
"Condition H" is in place throughout the country and was piloted in several Texas Health hospitals prior to systemwide implementation. The unfounded fear was that "Condition H" would be misused, but that was not the case. In fact, during the pilots, "Condition H" notification was proven to be helpful for patient care.
Reviewed and approved by the Performance Improvement Patient Safety Council (PIPSC) and the System Performance Committee (SPC), this patient safety program is now in place at all Texas Health entities.
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Patient safety enhanced through common wristband colors
Many hospitals around the country have been using color-coded patient wristbands to give caregivers immediate information on a patient's health status or condition. Beginning this summer, all Texas Health Resources entities will be using a standardized set of patient alert wristbands, and soon all hospitals in Texas and nationwide will be using the same colors.
Five wristbands are being adopted by all Texas Health entities. Red (allergy), yellow (fall) and purple (DNR - Do Not Resuscitate) wristbands are being used in hospitals throughout Texas and the United States. Additionally, green (isolation) and blue (OSA - Obstructive Sleep Apnea risk) wristbands are being used at Texas Health hospitals.
An important part of patient care and patient safety, wristbands will be applied at time of admission. Patients and families will be informed about the alert wristbands.
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Texas Health Dallas Cardiac Experts Collaborate with Team from Duke University Medical Center
 Tens of thousands of North Texans enjoy small-town life in rural communities outside the hustle and bustle of downtown Dallas. These far-away suburbs offer a quiet, simple life enjoyed by families and retirees who want a break from the hectic buzz of the big city.
But living in these communities also comes with a price: residents are far away from major medical centers with advanced interventional cardiac procedures that can mean the difference between life and death.
"As the Metroplex expands, there are more and more residents further away from the hospitals that have these specialized heart procedures," said Dr. John Harper, a cardiologist on the medical staff at Texas Health Presbyterian Hospital Dallas, where cardiac patients are brought from all corners of the region. "The challenge is that there inevitably will be people in these remote suburbs who suffer heart attacks - and how quickly they're transported to hospitals like ours and properly treated impacts their recovery."
Texas Health Dallas recently held a special two-day conference with emergency-response experts from Duke University Medical Center, which pioneered many of the national standards for efficiently transporting heart-attack patients from small, outlying hospitals to major medical centers. Duke has published research about their acute heart attack response system for patients who live in rural communities outside Durham, North Carolina.
The Duke team visited several Texas Health Resources hospitals, including Texas Health Dallas, Texas Health Kaufman, Texas Health Allen and Texas Health Rockwall.
While the cardiac catheterization laboratory at Texas Health Dallas is where many heart attack patients are ultimately treated, a smooth transfer system from the smaller, regional hospitals is a key link in the success of the system.
"Every step in the process - from the paramedics in the field, to the local hospital, to how quickly we transfer them here and get our on-call catheterization team in place - impacts how quickly the patient is treated," said Jon Gardner, administrative director of the Heart & Vascular Service Line at Texas Health Dallas.
The weekend conference involved an analysis of the system for treating patients who suffer a STEMI (ST-elevation myocardial infarction). A STEMI is a common type of heart attack that involves a blood flow problem in the heart. The circulation of blood can be interrupted by a collapsed artery or blood clot. This condition, which can cause permanent damage to the heart muscle in a matter of minutes, is one of the leading causes of death in the United States.
The Texas Health Dallas initiative in North Texas is called STEER (ST Elevation Emergency Response).
"There's a strong passion for this program among all of us here at Texas Health Dallas because we know how much it impacts the lives of our patients," said Paula Spencer, RN (pictured in far left of picture above), the chest pain coordinator at Texas Health Dallas.
Many times, the best way to treat the heart attack is with an interventional cardiac catheterization procedure that involves inserting a tiny wire into a leg artery. The wire is guided through blood vessels to the site of the blockage. A tiny balloon at the tip of the wire is then inflated to open the coronary artery, and a small metal stent or mesh is often inserted into the artery to help it stay open. The procedure, called percutaneous coronary intervention, is not offered at all hospitals.
The amount of time that elapses from the moment the patient crosses the threshold of the first hospital, even if that facility is in Rockwall or Kaufman, to the time the balloon is inflated to restore blood flow at Texas Health Dallas is called door-to-balloon (D2B) time.
Major clinical studies, endorsed by the American Heart Association, have shown that treating heart attack patients within 90 minutes of arrival significantly reduces damage to the heart muscle.
"The importance of this conference is that it's another example of the commitment by physicians on the hospital's medical staff, the EMS personnel, and our emergency room and cardiovascular staff at Texas Health Dallas to provide evidence-based health care in an efficient, quality way," said Dr. Ken Saland, an interventional cardiologist on the medical staff at Texas Health Dallas.
Numerous patients brought to Texas Health Dallas with a STEMI from areas outside Dallas city limits have been cared for in under 90 minutes.
"Our system is efficient, but the goal is to always improve and to always look for ways to get better at what we do," said Dr. Sean Black, an emergency physician at Texas Health Dallas. "It's important because we know that it's not simply a quick time we're looking to achieve; we know that the sooner you treat a heart attack patient, the better chance you have to save heart muscle and, in many cases, save lives."
The Duke team looked at every aspect of treatment of "remote STEMI patients" at several Texas Health Resources hospitals around Dallas. The emergency rooms at outlying hospitals play a critical role in the process, since that's where the heart-attack patients typically arrive first. "That's the 'front door' of the hospital, so providing rapid cardiac assessments and efficiently communicating and implementing the remote STEMI transfer system is critical to achieving the best care for patients," said Jenny Underwood, RN, a critical care specialist at Duke who was on-hand to share her knowledge of remote STEMI care with the Texas Health group.
"I think there's a stronfg system in place here in the North Texas area, but there are always opportunities to improve how things are done," said Dr. George Adams, a cardiologist on the medical staff at Duke University Medical Center who assessed the North Texas system. "There are a few hints we can pass on to them, fand there are some things we can learn from them."
"Preserving more heart muscle helps the patient survive the heart attack and improves the long-term survival and quality of life for patients," said Zoe Terral, director of invasive and non-invasive cardiology at Texas Health Dallas. "It's rewarding every time we're able to effectively care for someone suffering a heart attack."
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Texas Health Plano taking "SMART" approach to improving patient care
 Described as a fast-paced journey to improve a patient's hospital experience, Texas Health Presbyterian Hospital Plano is working on improving and fine-tuning processes currently in use. Project SMART (Systematic Methods Achieving Rapid Transformation) is a 64-week process currently being rolled out at Texas Health Plano; it focuses on enhancing patient care delivery systems and metrics management so that communication amongst patients, employees and physicians on the medical staff runs smoothly.
Through this transformation process, Texas Health Plano has been working with EMPATH, a national consulting group. Starting with the Emergency Department (ED) and Inpatient units, two of the project goals are to achieve wait-time reduction in the ED and improve communication and workflow between departments.
In fact, hospitals that have worked with EMPATH, such as Sacred Heart Medical Center, the second largest hospital in Washington State, report several key findings:
- ED arrival to bed placement: 75 to 18 min.
- ED bed placement to physician exam: 62 minutes to 9 min.
- ED volume: up 20%
- Inpatient admissions: up 15%
"In its first eighteen years of providing quality healthcare for the communities we serve, the clinical and non-clinical employees of Texas Health Plano have clearly established the success and significance of our hospital," said Dr. Jeffrey Canose, Texas Health Plano president. "However, with all of the changes taking place in healthcare - both locally and nationally - our new watch words must be 'strategic challenges' and 'sustainability'. Project SMART - our strategic collaboration with a nationally recognized best-practice leader, EMPATH - is an essential, mission-critical effort to achieve and maintain sustainability, where the first choice of patients to receive hospital care in our community becomes Texas Health Plano," said Dr. Canose. "This goal transcends what we call 'excellence' today. It is intended to position Texas Health Plano at a level of performance that not many hospitals can match," said Dr. Canose.
For more than three months, several EMPATH consultants have been working with Texas Health Plano's ED and Inpatient departments. The Project SMART Leadership Team includes:
- Dr. Jeffrey Canose, Operating Room Project Sponsor (Texas Health Plano President)
- Mike Evans, ED Project Sponsor (Texas Health Plano Chief Operating Officer)
- Eileen Hoffman, RN, Inpatient Project Sponsor (Texas Health Plano Chief Nursing Officer)
- Angie Simmons, RN, ED and Perioperative Services Project Liaison
- Michele Webb, RN, Inpatient Project Liaison
- Kerrie Burnside, RN, ED Associate Nurse Consultant
- Carmencita Cava, RN, Inpatient Associate Nurse Consultant
- Sabrina Lundberg, RN, Perioperative Associate Nurse Consultant
The tentative date of implementation for the majority of the hospital units is slated for June or July. "New processes will always be created with the needs and comfort of our patients foremost in our mind," said Michele Webb, RN, Inpatient Liaison. "We will address many challenges in order to improve the health of the people in the communities that we serve at Texas Health Plano."
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Texas Health Allen's Breast Center, continually helping women in the communities it serves
 An estimated 182,460 new cases of invasive breast cancer are expected to occur among women in the United States this year. And for American men, 1,990 new cases are expected to occur in 2009. Breast cancer is the most frequently diagnosed cancer in women, and despite the large numbers, Texas Health Presbyterian Hospital Allen's Breast Center continues in the fight against cancer and early detection. And the center's steady increase in volume for all procedure types is a sign that women in the surrounding communities are heeding to the message.
The last quarter of 2008, the Breast Center had a total of 2,365 breast cancer risk assessments. During the first quarter of 2009, that number increased by more than 100, and in January 2009, a new breast surgeon joined the Texas Health Allen medical staff, Radha Iyengar, MD. "We have a well-educated and health conscience population with many women realizing the importance of being proactive rather than reactive in regards to breast cancer," said Dr. Iyengar. "Women need to know their bodies and recognize when changes occur. Being aware of your own personal risk for breast cancer in addition to initiating screening at the appropriate time are the keys to early diagnosis and treatment."
The Breast Center has available various imaging techniques, such as digital mammograms, breast ultrasound and breast MRI. The center also offers minimally invasive needle biopsies, including MRI-guided breast biopsies. Using technologically advanced equipment, Jennifer Massengale, MD, diagnostic radiologist on the Texas Health Allen medical staff, performs breast MRIs on women who are at increased risk of developing breast cancer, women with a new cancer diagnosis and to evaluate breast implants.
"Using a dedicated breast coil and a digital imaging workstation to evaluate the enhancement characteristics, we can provide a more accurate reading and plan for an MRI-guided biopsy when necessary, said Dr. Massengale. One of my main goals is to provide focused, individualized care to each patient."
Barbara Quast, RN (pictured above, right), Women's Health Service Line director for Texas Health Allen explained one credit to the increased volume is the hospital's service in the local community. The center recently received a $20,000 grant from the North Texas Affiliate of Susan G. Komen for the Cure®. "This allows us to offer 100 free digital screening mammograms this year to eligible females," said Quast.
According to Quast, it is also their goal to make the patient aware that her health is of our utmost concern. "Some breast centers send letters to patients for follow-up exams. That's not our style; we personally call patients for call-back exams - that personal touch makes a difference."
"Showing our continued support in the community, beginning in June, we'll be working with Gilda's Club North Texas on a new support program for cancer patients and their families," said Quast. The program, "Living Beyond Cancer," will take place monthly, June through August. The first seminar, "Nutrition During and After Treatment," is Thursday, June 18, from 6 - 7:30 p.m. in Texas Health Allen's Conference Room. For more information on the Breast Center and its upcoming events, contact Barbara Quast, at 972-747-6238 or e-mail BarbaraQuast@TexasHealth.org.
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Texas Health Dallas implements physician hotline for sharing concerns, feedback
We Heard You.....
You told us we needed to do a better job of responding to your concerns. As a direct result of this feedback, we are implementing a physician-friendly mechanism for you to give us your concerns and feedback requiring management follow-up or to communicate a compliment about a staff member who went above and beyond the call of duty.
Starting May 26, 2009, extension 4372 will be dedicated for physician use and will be available 24 hours a day, 7 days a week. The HealthCare Improvement Department will be responsible for communicating your concerns to the appropriate manager or director. The investigating manager will investigate and follow-up with you within two working days. A mechanism is provided for additional time to investigate, if needed. Each month, the HealthCare Improvement Department will forward the information to Senior Leadership and the Medical Board to improve communication about specific issues and any trends over time.
You spoke and we listened. We look forward to working together to continue to improve the health of the people in the communities we serve.
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Intensivists give focused attention to critically ill patients at Texas Health Dallas
 When a patient is placed in the Intensive Care Unit at Texas Health Presbyterian Dallas, they receive state of the art care from one of North Texas' first hospitals to take advantage of an intensivist program.
Intensivist programs allow a doctor who specializes in working with the most critical patients to be a permanent manager of their care. The intensivist program provides doctors trained for an acutely ill patient population requiring round the clock attention.
Board certified Intensivists are in the units 7 days a week. On weekends and after hours Fundamental Critical Care Support physician extenders are there to initiate care, rapidly evaluate patients and collaborate with the Intensivist who is on call to assist. Texas Health Dallas' program includes multidisciplinary rounding, with evaluations from critical care physicians, ICU clinical supervisors, nurse practitioners and pulmonary therapists.
"The traditional model is to have pulmonologists and other critical care physicians on-call," said Dr. Gary Weinstein, chief of critical care medicine at Texas Health Dallas and a pulmonologist on the medical staff at the hospital.
The implementation of this program allows intensivists to give focused attention to their patients without other obligations at practices elsewhere. "Placing critical care clinicians in the unit, where, at the most, they're only a few feet away from the patient, is an effective system that may improve patient outcomes and reduce lengths of stay," Weinstein said.
Phyllis McCorstin, R.N., clinical nurse specialist for Critical Care/Cardiology Services at Texas Health Dallas, agrees that the program could reduce the length of stay for patients as well as decrease hospital readmissions and increase patient satisfaction. McCortsin also believes the program to be proactive in that it could reduce human error, and cut time in explaining cases to individual doctors placed on call. "It's an effective way to care for critically ill patients, and it increases the collaboration and communication between the various health care professionals caring for the patient," McCorstin said.
This program has been implemented at Texas Health Dallas' two intensive care units and is expected to improve not only the patients communication with their care team but also quicken the response time in their most critical time of need.
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Data integrity and clinical documentation: Texas Health providing a comprehensive view of quality
A program focusing on complete and accurate clinical documentation is being implemented across the Texas Health Resources system. The program is just one example of Texas Health's commitment to proactively providing a comprehensive view of quality patient care.
Collaborating with J.A. Thomas & Associates, Inc., a national consultant group, Texas Health is offering continuing medical education (CME) credit-approved programs and consultations for physicians on the medical staffs at all Texas Health hospitals.
The Compliant Documentation Management Program® (CDMP®), the official name for the project, is a multi-disciplinary approach to promoting the achievement of complete and accurate clinical documentation. The program goals include:
- Trained nurses who concurrently review clinical documentation to identify unclear clinical documentation;
- Accurate medical record documentation to support compliance with official coding guidelines and payor requirements;
- Complete medical record documentation describing a patient's conditions, procedures and severity of illness; and
- Accuracy in both hospital and physician data reported for quality purposes.
Texas Health first implemented the program at Texas Health Harris Methodist Hospital Hurst-Euless-Bedford in August, 2008 and then in September of 2008 at Texas Health Arlington Memorial Hospital. Both Texas Health Presbyterian Hospital Dallas and Texas Health Presbyterian Hospital Plano began the program in December, 2008. Carrie Upton, Team Lead for Clinical Documentation at Texas Health Plano said, "It is an opportunity for the hospital to work collaboratively with physicians on the medical staff -- one more component of the hospital's commitment to quality."
This year, beginning with Texas Health Harris Methodist Hospital Fort Worth, CDMP® will soon be implemented at all Texas Health hospitals. Senior Vice President and Texas Health Chief Compliance Officer, Elaine Anderson said, "A consistent and dedicated approach to complete and detailed clinical documentation at all levels is important to proactively meet regulatory requirements and provide the data needed for quality reporting and measurement purposes."
In order for Texas Health hospitals and the physicians on the medical staffs to better serve patients, proactive educational programs such as the CDMP® are key to data integrity and providing a more comprehensive view of quality.
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Briefly Speaking
Sonya Merrill, MD, physician on the medical staff at Texas Health Presbyterian Hospital Dallas, received the Texas Health Resources award for Outstanding Community Service by a Physician...Phil Wentworth, former president of Texas Health Presbyterian Hospital Plano, has been named acting president of Texas Health Dallas...Last day for Texas Health Dallas President Mark Merrill is May 22... Tom Shires, MD, chair of surgical services at Texas Health Presbyterian Hospital Dallas, has been voted president-elect of the North Texas Chapter of the American College of Surgeons....Paul Guttuso, MD, from Texas Health Kaufman was given the honor of being the Texas Physician of the Day on April 14, where he was the physician for the House and Senate.
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