Friday, October 22, 2021

Greater Baltimore Health Alliance Leads the Pack in the Maryland Primary Care Program

This week I would like to highlight the fantastic work being done by our Patient Centered Medical Homes led by Dr. Gregory Small, Medical Director of GBMC Health Partners Primary Care.

The Maryland Primary Care Program (MDPCP) was created by the Centers for Medicare and Medicaid Innovation and the State of Maryland to improve health outcomes and the care experience while reducing costs for Medicare beneficiaries. MDPCP provides funds to practices which, for example, hire care managers to work with providers to improve health outcomes. Since 2019, the program has helped create more advanced primary care practices that are better equipped to keep patients with chronic diseases, such as diabetes, out of the hospital and as healthy as possible.

The run chart demonstrating the performance on diabetic outpatient management (Hemoglobin A1C rate out of range), an internal measurement across all practices for diabetes control, demonstrates that we are doing very well against national comparisons. Also, six out of the 10 GBMC primary care practices that participated in the MDPCP in 2020 were at or above the 75th percentile for diabetes control compared to all the other practices in MDPCP – now numbering approximately 400.

Dr. Small attributes this success to the development of a dedicated diabetes care pathway. Spearheaded by a diabetes committee in which he chairs, the pathway outlines how to approach a poorly controlled diabetes patient and deploy a care team, specifically our RN care managers. Our care managers are important partners on the team with physicians, advanced practitioners, and medical technicians, working with patients to ensure the necessary care and  that they are following evidence-based protocols to maximize their health.

The team also leverages technology to increase patient engagement. Tools including electronic  flowsheets that are visible to patients and the care team allow for more effective communication beyond what happens during office visits. 

Blog readers know that advanced primary care is a fundamental building block of the GBMC HealthCare System. The PCMH is critical to preventing disease and coordinating care for people who already have chronic disease. Let me thank Dr. Small and all of our primary care teams!

International Infection Prevention Week

This week is International Infection Prevention Week (Oct. 17-23). This is  a time to highlight the importance of infection prevention and raise awareness of everyone’s role in protecting the public from healthcare-acquired infections. Infection prevention initiatives include hand washing, employee education related to safety and infection control, sharing best practices, and tracking improvements in performance.
GBMC is fortunate to have an incredible Infection Prevention Department and they have been tremendously important during the pandemic.

I want to thank our Infection Prevention team members for all they do every day!

GBMC Team…Please get your flu shot!

Studies have shown that as many as 1 in 2 infected people never show classic flu symptoms but can shed virus for 5-10 days. This means that asymptomatic personnel can unknowingly spread influenza to a patient, co-worker, and personal contacts. If an employee contracts influenza they put patients, fellow staff, and their own family at serious risk.  For this reason, the annual flu vaccine has become a standard of care for healthcare providers. 

GBMC employees and volunteers are required to be immunized (those few who are not required to be immunized are required to wear masks during the flu season) to protect ourselves and our patients.  Getting your flu shot is even more important as the challenges of the COVID-19 pandemic remain.

The deadline for influenza vaccination for all employees, contractors, volunteers, and students is Friday, Oct. 29.   We have two vaccination events coming up:

  • Sunday, October 24: 2:00 p.m. - 10:00 p.m., EHS Clinic, Room 4904
  • Friday, October 29: 7:00 a.m. – 3:00 p.m., Civiletti Conference Center

A valid GBMC ID badge must be presented at all flu vaccination events.

October is National Cyber Security Awareness month 

Our ITS team continues to do an outstanding job in defending our networks while preserving the efficient delivery of healthcare services.

We learned a lot from last year’s cyber-attack and we will continue to become stronger because of it. Please remain vigilant and do not click on links unless you are sure they are safe. Please remember to always bring a questioning attitude to your use of e-mail, the electronic record, and other applications. Do not click links unless you are sure they are  safe, do not go to websites you aren’t familiar with, and ask IT for guidance if something doesn’t quite “seem right.” The cyber-attack we experienced started with a phishing email, so it is critical to report any suspicious emails to IT. Together, using simple internet safety precautions, we can help keep GBMC safer from cybercrime.

I want to thank Dave Hynson, GBMC’s Chief Information Officer, and his team for all their hard work in addressing the issues and keeping our systems safe.

Monday, October 18, 2021

GBMC Meets Our Mission with Outstanding Support from the Community

Last Wednesday, patients at the Sandra and Malcolm Berman Cancer Institute at Crossroads were given cupcakes by the owners of Saffer Plumbing, Heating, and Electric.  This special treat was to commemorate Breast Cancer Awareness Month and was well received by our patients and staff.  And, the company’s generosity doesn’t end there!

Saffer Plumbing, Heating, and Electric, with the help of their specially decorated pink truck, is donating a portion of their business revenue to our Oncology Support Services to help our cancer patients meet travel-associated expenditures. Unfortunately, many of GBMC’s cancer patients need a ride to receive their scheduled treatments but lack consistent means of transportation. National statistics show that more than 60 percent of cancer patients missed or were late to an appointment because of transportation issues.

Under this new partnership, Saffer will donate about $5,000 a year to GBMC. The Saffer family chose GBMC because of close connections that include the hospital being the place where their children were born, and they have a family member who was a longtime physician at GBMC.

Brandon Costantino, manager of our Oncology Support Program at GBMC’s Sandra and Malcolm Berman Cancer Institute, recently answered some questions regarding this wonderful collaboration and its importance to our cancer patients.

Q: Can you give some details about our Oncology support program and how it helps our patients?
A:  Our Oncology Support Services department provides a wide variety of assistance including helping our patients get to and from their treatments. We also offer free counseling, education, and connections to organizations that can help patients and families shoulder the burden of treatment. Our goal is to reduce barriers to care. We want patients to be able to get their treatments on time, as scheduled, to achieve the best health outcomes possible. 

Q: What is the average cost for our patients who turn to public transportation or rideshare companies to get to their appointments?  How will this partnership help our cancer patients meet some of their transportation costs for coming to and from scheduled treatments?
A:  Some of our patients turn to public transportation or rideshare companies to get to and from their treatments.  The average cost per ride is $23.02, meaning that patients can spend an average of about $46.00 per visit. The average GBMC cancer patient requires at least 14 rides monthly. Most of us have had a family member, friend, or someone close battling cancer. Treatment is never easy, and at times the financial toll is overwhelming. 

The funds donated by Saffer Plumbing go into a restricted fund and can only be used for transportation. We then use those funds to provide rides to breast cancer patients who need transportation.  This donation will help provide over 200 rides to breast cancer patients. Again, we want to do everything we can to help meet basic financial needs, decrease stress levels, and allow patients with cancer to focus on healing. A donation like this makes a huge difference in our patients’ lives. 

Q: Whose idea was the pink truck?
A:  The pink truck belongs to one of the company’s plumbers whose grandmother is a breast cancer survivor.  When asked to participate in this endeavor he was honored.  One of his recent customers, when informed that part of the proceeds from that day’s work would go to helping breast cancer patients, was really touched.  It meant a lot to her being a cancer survivor herself.  This truly shows the value of this initiative.

Thank you, Brandon, for the valuable information and my gratitude to Saffer Plumbing, Heating, and Electric for doing what they can to help our patients get to their cancer treatments. 

Another Group Helps Our Cancer Patients
Recently, members of the Alpha Kappa Alpha Sorority, Inc. - Upsilon Epsilon Omega Chapter, donated chemo care packages to our patients. The care packages included a journal, lotion, Queasy Pops, hand sanitizer, socks, snacks, and more! 

People living with cancer benefit from the power of human connections. These carefully selected products are geared to help ease the short-term side effects of treatment and brighten a cancer patient’s day.

I would like to thank Dawn C. Stefanik, AA, MLT, BSN, RN, OCN, Nurse Manager- Infusion & Infusion Pharmacy at our Sandra & Malcolm Berman Cancer Institute, for helping to coordinate this work.

Again, we are so grateful for the generosity of the community and truly appreciate their help in brightening the day for our cancer patients. 

Thank You!
There is no question that Emergency Department nurses have some of the hardest jobs and make an immense difference when every second counts. They have the expertise in caring for all emergencies, across all stages of life, and they work very hard. 

Last week we celebrated Emergency Nurses Week. I want to thank our ER nurses for making a difference in the lives of people every day, every shift. Now more than ever, it’s important to recognize and appreciate their commitment in caring for our patients.

Friday, October 8, 2021

Celebrating Gilchrist’s New Home in the City

Last week I had the pleasure of attending the ribbon cutting ceremony at the Gilchrist Center Baltimore’s new Inpatient Hospice facility at Stadium Place. 

By the end of October, we will start to provide respectful end-of-life care to many in need in the city of Baltimore. The new center will continue to be the only residential hospice in Baltimore and the only pediatric inpatient hospice unit in the state. 

The 30,000 square-foot William L. and Victorine Q. Adams Gilchrist Center Baltimore will contain 18 private adult rooms and four pediatric rooms for inpatient residential hospice and respite care. The center has been designed with the warmth and comfort of Gilchrist’s other inpatient centers in Towson and Howard County, with home-like areas for families who are visiting. Each patient will have access to the full spectrum of hospice care, including medical, emotional, spiritual, and personal care, with a focus on quality of life. Music therapy, veteran salutes, counseling, and bereavement services will also be available free of charge. 

My deepest gratitude to Cathy Hamel, President of Gilchrist and Vice President of Continuing Care at GBMC HealthCare, and Dr. Tony Riley, Chief Medical Officer of Gilchrist, and their entire team for their devotion to their patients and families. I congratulate them once again for this milestone occasion.  

Thank You!
Earlier this week, we had an unfortunate incident on our medical campus.  Thankfully no one was physically injured or harmed. The safety of our staff, patients, and entire GBMC family is of the utmost importance. I want to thank our security team and incident command center for their quick response and action to protect our staff, volunteers, patients, and visitors. 

Last Thursday, we held our annual employee and volunteer barbeque. Normally, we hold this event during the summer, but we thought that having it in September would be a welcomed change, especially given the pandemic. The great weather and the spectacular karaoke performers and bean toss participants helped make it a really a fun time!

I would like to acknowledge our Human Resources Team, led by Anna-Maria Palmer,  Vice President of Human Resources and Chief Human Resources Officer, and her executive assistant, Richelle Tighe, as well as the Marketing and Communications Team and our Philanthropy Team, led by Jenny Coldiron, for putting on a fabulous day-long barbecue! I also want to give a special shout out to Cristie Nickel, Community Relations and Events Specialist, and Kim Davenport,  Director of Communications and Event Management Strategy, for their hard work on this year’s events.

October is American Pharmacists Month
At GBMC, we have always had outstanding pharmacists and technicians who really care and work hard. Over the years, our pharmacy team, led by  director, Yuliya Klopouh, has done an outstanding job at making our medication delivery highly reliable. They were phenomenal after the cyber-attack. They really showed their expertise at redesign. Please join me in thanking them for all that they do to drive us closer to our vision. 

Happy Anniversary, Times Two!
Last Friday (October 1st), we hit two major milestones. It was GBMC’s 56th anniversary and it was also the five-year anniversary of going live with Epic – our electronic medical record (EMR) across the GBMC HealthCare System. I can’t believe how time has flown.  It is clear that “one patient, one record” has been a major benefit for our patients and for the GBMC HealthCare System.

Thursday, September 30, 2021

Remembering and Honoring A Legendary Physician

"If you’re going to live, leave a legacy. Make a mark on the world that can’t be erased.” - Maya Angelou, author

Last week the GBMC family lost a legend and a GBMC Physician Titan.  Dr. Rudiger “Rudy” Breitenecker was a true icon and a pioneer for his work in forensic pathology. 

Before becoming a member of GBMC's Department of Pathology in 1967, Dr. Breitenecker was a state medical examiner. A realization that rape victims were not always achieving justice prompted him to found GBMC's Rape Care Center – the precursor to our current Sexual Assault Forensic Examination (SAFE) Program. Here Dr. Breitenecker applied the knowledge he gained while collecting evidence for city homicides to the collection of evidence in rape cases.

Dr. Breitenecker was trained as a forensic pathologist and he froze samples of fluid from each case, preserving the evidence for the future. His decision to save samples, plus Maryland's no statute of limitations on rape, helped many women get closure on their cases even years later. 

A pioneer in sexual assault forensics, Dr. Breitenecker participated in more than 2,000 rape cases and was often the only physician to testify in court. Although he retired in 2008, he remained active in the field and consulting as an expert witness.

His work helped the Baltimore County Police Department become one of the first departments to access clinical evidence from a hospital in cases of rape. Department Sergeant Rose Brady, said, "Dr. B. absolutely deserves all the honors that are given him."

I am honored to have known Dr. Breitenecker and I am thankful for his innovative work.  Please join me in remembering Rudy’s life and legacy. And please share your memories of him here.


Please join me in congratulating Joel Turner MD, FACS, as the new Chairman of the GBMC Department of Surgery and head of the Surgery Service Line.  

Joel came to GBMC after he finished training in General Surgery and he has been a member of Finney Trimble Surgical Associates since that time.  Dr. Turner previously served as Vice Chair of the Department of Surgery and Chair of the Surgical Value Analysis Committee.

I am grateful for Joel’s stepping up as Chair and I look forward to his leadership of our surgery program. 

Congratulations also to Rebecca “Becky” Stover, RN, on her promotion to Director, Project Management for the hospital work system.

In this new position, Becky will support hospital-wide projects including the Promise Project.

Since starting at GBMC in 2009, she has managed Safety Officer training and our annual Art of Nursing event. Becky has done an exceptional job in managing these and other projects and we look forward to her leadership in helping us complete the many initiatives underway and those coming in the future.

Friday, September 24, 2021

The Hospital: A Very Expensive Pathway of Least Resistance for Broken Systems

Recently, we discharged an, intellectually disabled patient after a stay of 257 days in the hospital. 

The patient, who was over 50, originally presented to the Emergency Department with her group home caregiver. In the several months prior she had been in and out of the hospital and psychiatric facilities with behavior related issues such as throwing herself on the floor. The reason for her admission to the hospital was that she was acutely unable to walk. She was sent to our Integrative Care Unit with a diagnosis of an infection. 

Her infection was treated, and she returned to her previous state of health after a few days of care- the work of our Integrative Care Unit was done. 

And then the waste began since she no longer needed to be in the expensive setting of the acute care hospital. GBMC has no inpatient psychiatric unit to provide treatment to a patient like this. For the next step in discharge, the question then became whether she would go to subacute rehab, long term care, or back to her group home. She is financially supported by the State, through the Maryland Developmental Disabilities Administration, since she is not capable of supporting herself.  

During her hospitalization the patient would frequently act out, screaming, cursing, and exhibiting other attention seeking behaviors. Due to her high acuity behavioral needs, she was initially recommended to go to a neuropsychiatric disorder unit, but a bed was not available. Then the care team learned that she had exhausted her lifetime Medicare days but that her Medicaid benefit had not yet kicked in. By the time she became Medicaid eligible roughly two months later, the team learned that she could not go to the neuropsychiatric unit and she would have to be admitted to a state operated facility. 

We know that the longer someone remains in the acute care hospital, the more at risk they are for hospital acquired conditions. This patient developed a hospital acquired condition and was transferred to another unit where she stayed for 36 days. She was then transferred back to the Integrative Care Unit.

During this time, planning for her discharge continued. Her family was hoping for a group home placement closer to where they lived. Over the next few months, the patient was declined by several facilities as they were not able to accommodate her needs. 

During her sixth month of hospitalization a facility reviewed her case and subsequently approved her for admission. However, the facility had not yet been approved by the Developmental Disabilities Administration, so the team continued to wait. It was only recently that the team learned that the facility had been approved and they were finally able to plan for her discharge. 

The Integrative Care Unit Team was incredibly resilient in caring for her. They took turns reading books to her. The patient loved our volunteer guitarist Chris Maggitti and would sing along when he played for her. Nurse Manager Carolyn Keller took her to our beauty salon in the West Pavilion twice for a haircut during her stay, which was challenging due to her behavior. Lisa Palmer, our hairstylist, was patient and compassionate. Dr. Rebecca Moore from psychiatry managed the patient’s medications which at times needed to be adjusted daily to control her behavior. Dr. Moore had a wonderful relationship with this patient. Dr. Rachna Raisinghani, the unit’s Medical Director, spent much time assisting to find a placement for the patient.  Sarah Sackett from social work worked tirelessly, day in and day out to advocate for her and to coordinate the safest and most appropriate placement. Our Hospitalist Team also deserves recognition for being there to support the patient through her entire stay and for attending to any issues that arose. The entire Integrative Care Team went above and beyond to provide kind and compassionate care to a patient who was incredibly trying to care for, as GBMC does not have the resources to provide inpatient psychiatric treatment or residential psychiatric care. 

The case underlines the need for redesign of the behavioral health system and for the simplification of our health insurance system. The acute care hospital is often used as the pathway of least resistance to care for behavioral patients and the public should demand that leaders step up to find a better way. 

Please join me in thanking everyone that cared for this patient. They were determined to make things as good as they could even though the patient was not in the right setting. We are indebted to all of them. 

Friday, September 17, 2021

Back to Life

On Tuesday afternoon, I had the privilege of being part of a special event with a grateful family whoselife-altering experiences played out right here at GBMC.   

Back in early July, Kathy Patten was slated to play golf with family and friends when she got the call that her daughter, Stacey Fifer, was going into labor at our hospital. Due to the easing of COVID regulations for a patient’s family and friends at that time, Kathy decided to join Stacey and her son-in-law, Richard Fifer, in our pre-birthing room.

After arriving to attend the birth of her grandchild at GBMC, Kathy started to not feel well. Stacey became worried about her mother, and she called her nurse Kiana Dowdy, RN, to have her mom checked out. Kiana evaluated Kathy, put her on a cardiac monitor, and called for the Rapid Response Team. The team decided to take Kathy to the Emergency Department for further evaluation.  As they were leaving Labor and Delivery, Kathy went into cardiac arrest. They began CPR and called for the Code Team.  Drs. David Vitberg and Ari Zaiman ran to Labor and Delivery with the rest of the Code Team. They were joined by Dr. Dov Frankel from the Emergency Department and they managed the Code. The Labor and Delivery charge nurse Michelle Lukehart, RN, along with Rebecca Rubin, NP, took on critical roles during the code and also in assuring that all of the patients in the Unit got excellent care. Melanie Dowell, the Parent Education and Doula Program Manager, stayed with Stacey to assure that she was OK. Meghan Shackelford, NP, the Director of Advanced Practitioners, assisted the code team in L&D and also followed the team to assist in ongoing stabilization in the ED. After 48 minutes of cardiopulmonary resuscitation (CPR), and just before the Team was going to end the Code, Kathy’s heart began to beat again, and she awoke. After further outstanding stabilization, by Dr Frankel and our ED team, Kathy was then transferred to the University of Maryland St Joseph Medical Center and there she received wonderful cardiac interventional care and was set on a pathway for cardiac rehabilitation. 

Despite her intense worry about her mother’s condition, Stacey’s baby was on its way into the world, and she continued with the delivery. Hoping to have a natural childbirth, the baby became stuck in the birth canal requiring an unexpected caesarian delivery and a neonatal resuscitation. After a relatively brief stay in GBMC’s Neonatal Intensive Care Unit (NICU), Alora is a happy, healthy baby girl. 

Kathy, who essentially came back to life following this astounding near-death experience, is now fully functioning and enjoying her life as a mom, grandmother and grateful former GBMC patient.  

At this week’s event, Kathy, Stacey, and other Patten and Fifer family members expressed their gratitude to the GBMC team that brought Kathy back to life and who served Stacey and Alora so well. Drs. Vitberg and Frankel reflected on the outstanding work of all involved, starting with our Labor and Delivery staff and including all those who assisted. Dr. Vitberg commented that our staff has been under so much stress since the beginning of the pandemic and following the cyber-attack and that this life-saving event was so helpful to replenish the energy and spirit of all the GBMC staff involved. 

This story further highlighted to me that the hard work of clinicians who care and are experts in their field is necessary for outstanding performance. Well-designed systems are also necessary, as is training as a team for infrequent and life-threatening situations like the one the team encountered with Kathy that day in July in Labor and Delivery. Dr. Vitberg and his team train regularly in our simulation center and GBMC recently earned the official designation as a Resuscitation Quality Improvement (RQI) Lighthouse Organization for our adoption and consistent use of an innovative CPR training program. GBMC is the first hospital in Maryland to receive this designation and to use the RQI system to train nurses and other clinical providers in CPR. This recurrent training and testing of CPR competency played a role in keeping Kathy’s brain oxygenated when her heart was not pumping for 48 minutes!

I am in awe of the entire team that was involved in saving Kathy and in serving Stacey and Alora as well. Great work and Thank You!

Thank-You EVS Team
This week, we are celebrating Environmental Services (EVS) and Housekeeping Week. After more than a year on the front lines of the COVID-19 pandemic, EVS and housekeeping professionals have served as a source of reassurance for patients unable to see loved ones, while maintaining rooms to the highest standards of cleanliness.  Our dedicated EVS and Housekeeping staff work day and night to keep our facilities clean and to prevent infections. They replace linens, remove regular and medical waste, and take care of unscheduled or emergency housekeeping services such as spills or event set-up. Please join me in thanking all our colleagues in EVS for their great work especially during these challenging times!

Neonatal Nurses Day
Last Wednesday (9/15) was Neonatal Nurses Day. We are very fortunate to have such a high-level NICU to care for those babies who are born too small, too sick or too soon. Please join me in thanking this exemplary group of nurses for all they do.

Yom Kippur
Yom Kippur, also known as the Day of Atonement, was this week and is the holiest day of the year for those of the Jewish faith. Yom Kippur has a unique place in the Jewish calendar. Following Rosh Hashanah – the Jewish New Year – Yom Kippur marks the end of the 10 days of repentance, which is a time to reflect on wrongdoings and pledge to do better as the New Year begins.

Friday, September 10, 2021

What about the Flu?

The 2021 influenza (flu) season is right around the corner. To predict how much influenza, we will see in the northern hemisphere, we look to the experience in the southern hemisphere. The good news is rates of the flu have been very low in the southern hemisphere just like last year. The biggest single reason for this is drop in cases is people are travelling less. They have also been wearing masks and practicing social distancing. So, there is a good chance that we will again see fewer than the average number of cases than we usually see in a year. 

However, experts worry that our antibody levels against influenza A in particular, may be low since we have not had much exposure to the virus over the past year or two. They are concerned, therefore, that we may have rapid spread of the flu virus once it becomes more widespread in the community. 

We can’t really know for sure what the flu season will be like, but we do know what we can do to limit the spread of the virus and keep ourselves healthy. Step 1 is to get vaccinated as soon as the influenza vaccine becomes available. Then, it will help to wear a mask, wash our hands often, and maintain social distancing if we do have outbreaks. Sound familiar?

Soon we will be announcing our 2021 employee influenza vaccination plan. I want to thank Sophia Powell, MSN, FNP-C, Occupational Health Director for the GBMC HealthCare system, for her hard work on the plan.  Next month we will be offering our employees their flu shots at several clinics to be held in our Civiletti Conference Center. Stay tuned for the specific clinic dates and times in the coming weeks.  

Happy New Year

Earlier this week was the beginning of Rosh Hashanah, the Jewish New Year. It is a holiday at the “head of the year” that comes at the close of the harvest, when the Jewish community of faith focuses on repentance.  L’Shana Tovah! Happy New Year 5782!

Remembering 9-11

As a nation, this coming Saturday we will recognize the 20th anniversary of the tragic events of September 11, 2001.  Like all Americans I was stunned by the events of that day and the great loss of life. I was somewhat buoyed by the phenomenal stories of those who gave of themselves for others in the days and months after 9/11.

As we look back at the terrible tragedy that occurred and the brave first responders who showed tremendous heroism in the hours and days thereafter, let us join together and work for peace and justice in the hope that events like these never happen again. Thank you!