EMS Week 2012

This week, Jeff Sternlicht, M.D., Chairman of Emergency Medicine at GBMC since November 2007 and a GBMC emergency physician for the past 14 years, is guest blogging.  GBMC’s Emergency Department experiences about 60,000 patient visits annually.

On average, more than 20 ambulances a day back into the bays at the Greater Baltimore Medical Center Emergency Department, each time with someone in the unit who has called 911 and needs medical care.

Sometimes, it’s a victim injured in a vehicle crash.  Or it may be someone having trouble breathing, someone who has fallen, or someone who just isn’t feeling very well.  That’s more than 650 times a month, and nearly 8,000 times a year that our clinicians will interact with an Emergency Medical Services (EMS) provider from the community, who has provided pre-hospital care and is relying on the expertise of GBMC doctors, nurses, techs and other staff to care for their patient.

This week in recognition of National EMS Week (May 20 – 26) I had the chance to ride along with Baltimore County Fire Department EMS 1 Captain Steve Adelsberger, a district supervisor  whose territory includes the Towson area.  It was a quiet few hours as far as call volume, but we had lots of good discussions about pre-hospital EMS care, emergency room care, and how their folks and our staff work together to provide the best possible experience for each patient.

We stopped by Fire Station 11 in Hillendale, and I had the chance to meet with the engine and ambulance crew, including a new paramedic and another who was completing his two-year practical exam. Sitting and talking with the crew about issues such as electronic medical records and utilization / waste of the 911 system, such as when patients call for an ambulance when they have a relatively minor “non emergent” situation, was a good experience and well worth taking a few hours away from the office.  It was reassuring to hear that EMS providers agree that too often, the emergency room is the path of least resistance for many in the community.

(Although this year it wasn’t as exciting as my EMS Week ridealong a few years ago when, as we were leaving the county’s 911 Center, we were dispatched to respond back to the center for a 911 operator having a headache and who had passed out).

One of the more interesting conversations I had with Captain Adelsberger and the Station 11 crew was around EMS calls to the many nursing homes, assisted living and other long-term care facilities, where the protocols for when to summon emergency assistance unfortunately vary greatly.  I was impressed that the county EMS personnel have a guidebook specific to responses for these facilities, but it would be great if the system were standardized.  For example, if each facility had the same cover sheet where the patients’ medications, allergies, vital statistics and chief complaint could be listed, that would make it much easier for the transition from facility to EMS pre-hospital care to hospital staff.

For the most part, the EMS pre-hospital care system works very well in Baltimore County. Operations are standardized, and it is very similar to the LEAN processes we are using at GBMC.

One example of the system working well with a successful outcome happened this past February. Seventy-year-old Ann Thiessen of Bel Air was working at the animal shelter in northern Baltimore County when she suddenly collapsed.  A co-worker who was a former volunteer EMS provider thankfully was nearby and performed CPR until an ambulance arrived and care was turned over to the paramedics.  The medic crew transported the patient to GBMC, where my colleague John Wogan. M .D. led a team who was able to save Thiessen.  She was discharged after a few days in the hospital. This is one of several “chain of survival” stories that will be shared at a very special event next Friday at Fire Station #10 in Parkville, where EMS providers will also encourage citizens to take a CPR class.

I also want to congratulate the county’s new EMS Director, Christian Griffin, who was promoted from the field recently.  Many of us working in the ED became familiar with “Griff” when he was working as an EMS 1 district officer.  I was able to spend some time at headquarters during the ridealong talking with Director Griffin and look forward to an excellent working relationship.

Even after the past 14 years as an emergency medicine doctor in the community, being able to experience stories like that remind me why I come to work every day.

Have you had a positive experience with the pre-hospital EMS system and GBMC that you want to share?

Fundraising – Rain or Shine

This week the skies looked grey but it was time for our 24th Annual GBMC Golf Classic and dozens of golfers were ready to tee up their balls Monday at Turf Valley Country Club and help raise funds for the GBMC HealthCare system.

I played in a foursome with Harry Johnson, Chairman of the GBMC HealthCare Board; Jim Albrecht, president of the GBMC Volunteer Auxilliary, and Bruce Campbell, of Wallace H. Campbell & Co., Inc. We had a great time even though we didn’t win and we got a little wet.

Hats off to Mike Forthman and the entire golf committee and to Jenny Coldiron and the GBMC Foundation staff, all of whom worked together for a great event in spite of the lousy weather.  We had 64 foursomes sign up – that’s 256 golfers supporting our efforts.

We’re still counting, but so far have raised more than $204,000 for various initiatives, including GBMC Medical Staff’s Nursing & Allied Health Professional Staff Education Fund which provides scholarships to nurses so they can receive the professional education and certification to provide the best health care for our patients; the Middendorf Consumer Health Library/ John E. Savage Medical Library which provides the medical staff, patients, visitors, and members of our community the most up-to-date medical information; and the Continuing Medical Education Department which provides programs offering medical education for our physicians, nurses, residents and other allied health professionals.

Every dollar that we raise from philanthropy takes the pressure off us of trying to find that dollar somewhere in operations.  I’m very grateful to everyone who helped us raise the money and everyone who came out to play.

At dinner, I chatted with Dr. Bernard McGibbon and learned that he started the tournament 24 years ago to encourage togetherness among the GBMC family and as a way of getting everyone to have some fun together.  Thankfully today those themes carry on for the Golf Classic.

Another major fundraiser for the GBMC HealthCare system is coming up in a few weeks – on Sunday, June 17th, we’re holding the 24th Annual GBMC Annual Father’s Day 5K & 1 Mile Fun Walk at the Baltimore Marriott Hunt Valley Inn to benefit the hospital’s Neonatal Intensive Care Unit (NICU).

It’s always an amazing sight to see hundreds of families come together for this great cause, with babies in strollers, wagons and carriers.  Knowing that so many of the babies, and the older kids as well, were at one time being cared for in the NICU and are now thriving and growing is a great sight to see.

Runners at the 2011 Father's Day 5K

GBMC operates a strong NICU with excellent clinicians, great care and the latest equipment but this comes at a cost. It’s very expensive to provide care for these small babies and sick neonates.  But again the fundraising efforts help a great deal.

In the past 23 years, the annual Father’s Day 5K & 1 Mile Fun Walk has raised more than $1.5 million for the NICU and so far this year we’ve already raised more than $60,000.

I encourage you to sign up today - Father's Day 5K Registration I’ll be out there running, come join me! Your support will touch more than 500 critically ill and premature babies cared for every year in GBMC’s NICU.

Here I am greeting a young runner last year. 

Your support is a big deal to GBMC’s smallest patients.

Did you participate in the GBMC Golf Classic or are you planning to participate in the Father’s Day 5K & 1 Mile Fun Walk?  Share your story of why you help fundraise for GBMC.

Training in Teams To Get To Higher Reliability

This week, GBMC took a significant step forward in our ability to make our care more reliable with the opening of our new Simulation Lab in the South Chapman Building.  Such technology is not frequently found at community medical centers. 

Kudos to the GBMC Foundation, who led the effort to raise $650,000 to make the idea for a simulation training lab a reality.  In particular, we appreciate the financial support from the LaVerna Hahn Charitable Trust, The Middendorf Foundation, and The Women's Hospital Foundation.

The notion of training as a team in a simulated environment is a huge step forward and is a critical part of our movement towards higher reliability, one of the underlying tenets of patient safety.

Commercial aviation – a field which we in healthcare often learn a lot from – has for years been using the simulation environment for training staff in preparing for low frequency, high-risk eventualities.  They don’t have a pilot simulation lab, they have “team” simulation labs where a pilot, co-pilot and other staff train together.  One of the reasons why Sully and his co-pilot were able to safely put their airplane down in the Hudson River ("Miracle On The Hudson”, January 2009) and everyone on board managed to escape without serious injuries was because they trained for eventualities. Although they didn’t plan for that exact scenario, they practiced and understood that time was of the essence in a high risk situation.

It takes a team to get it right for every patient, every time. Our teams now have the ability to train in a simulated patient environment to be ready for the real life situation.  

There’s an old adage in the medical profession “See One, Do One, Teach One”, where seeing, doing and teaching are all essential steps to one gaining new skills.  If it was your mother receiving care from a new medical professional you wouldn’t like that the trainees watched the procedure one time and then did it in real life. You’d much prefer that they began their learning in a simulated environment and not on an actual patient. 

Some staff have actually been utilizing the Simulation Lab already, and Nursing Education recently finished bringing new nursing graduates through the lab helping ready them for the beginning of their clinical experience.  Medical residents are planning time in the lab as well.

The lab includes five adult, two infant and one child mannequins – each with different functionalities designed to test various skills and simulate a wide range of real-life medical conditions.  

New graduates and Nursing Support Technicians for example can get basic and refresher training in skills such as starting IVs, taking blood pressure and monitoring other vital signs.  Some of the mannequins can simulate a patient’s chest rising and falling, shortness of breath and varying pulses. The “top of the line” mannequin, known affectionately among the training staff as “3G Man”, is almost lifelike.  His eyes blink, he sweats and drools, and staff can administer medications to him.  3G Man will also respond appropriately to actions taken by staff, so if they make a mistake – which is OK to do in the simulation training environment – he will respond accordingly and his condition will deteriorate.

The lab also features a dedicated Labor and Delivery Room, in which various mother and baby scenarios can be practiced.  The mother mannequin actually resembles a pregnant woman, and staff can administer an epidural and common drugs that would typically be found in a birthing situation.  Newborn baby and young infant  mannequins are also included to allow for various childbirth and Neonatal Intensive Care Unit (NICU) scenarios.

Our Maternal Newborn Health staff, through the Kaiser Perinatal Patient Safety Program, will also be training in Crew Resource Management (CRM) through a program called TeamSTEPPS - Team Strategies and Tools to Enhance Performance and Patient Safety.

The TeamSTEPPS program aims to provide higher quality, safer patient care by:

• Producing highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes for patients
• Increasing team awareness and clarifying team roles and responsibilities
• Resolving conflicts and improving information sharing and eliminating barriers to quality and safety.

TeamSTEPPS was developed by the Department of Defense Patient Safety Program in collaboration with the Department of Health & Human Services’ Agency for Healthcare Research and Quality.

The underlying concept of TeamSTEPPS is called Crew Resource Management (CRM), in which the belief is that team members all know their role and know who their leader is, but also understand that they are protected by the organization’s Just Culture and can speak openly in order to get the best possible outcome in an emergency.

Congratulations and thank you to all who made our simulation center a reality! The GBMC HealthCare system continues to improve and gets closer to our vision!

What do you think about the use of simulated training in teams? Please share your comments below.

Our Wonderful Nurses

Everyone knows that nurses are the backbone of a hospital, and it’s no different here at GBMC.  The 1,200+ nurses across the GBMC HealthCare system work very hard.

I’m very grateful for all that our nurses do.  At least once a year we should take the time to formally recognize our nursing staff for their dedicated service. National Nurses Week is celebrated annually from May 6, also known as National Nurses Day, through May 12, the birthday of Florence Nightingale, the founder of modern nursing.

There has been more and more required of nurses every year and I’m always amazed at how they keep coming back because they realize that their life work is about helping others at a very vulnerable time in their lives, which is when they are very sick.

I remember all of the nurses who, when I was a pediatric resident, helped me learn the evaluation of a very sick baby or child.  Later in my career as a doctor I had the greatest respect for nurses who worked with us in a high-volume primary care practice to help us get through the day and make sure every family got what they needed. I was very grateful for the team I worked with and nurses were a very prominent part of that team.

In healthcare, the stakes keep getting higher and the number of very complex patients keeps growing along with the age of the population. Our nurses meet this growing demand every day.

Nursing has always been a marvelous profession and it will remain a marvelous profession in the future. I’m delighted to see at GBMC that we have many younger nurses early in their career, in large part due to the forward-looking efforts of our nursing executive team led by Jody Porter, RN, DNP.  We’ve been able to recruit young nurses, train them well and mentor them, making GBMC a great place for nurses to start their career.

Our current nurse vacancy rate is just slightly above 2%, and we have consistently been below both the statewide and national nurse vacancy rates, another testament to the excellent work led by our Nursing Administration and Nurse Recruiting teams and Nursing Education staff.

How has your life, professionally or personally, been touched in a positive way by a nurse?  Please share your comments below and show our nurses how valuable they are.

This year, at the same time when we recognize our nurses, we are also celebrating National Hospital Week, also May 6 – 12.  Hospital Week, which dates back to the early 1920s, is, according to the American Hospital Association, “a celebration of the history, technology and dedicated professionals that make our facilities beacons of confidence and care.”  This year’s theme is “Making Miracles Happen Inside the Walls of GBMC,” something that our committed GBMC staff – nearly 3,900 employees across the system - does every day.

I invite you to participate in various Hospital Week events at GBMC, including:

·         Word search & GBMC trivia game on the Info Web with prizes (entries for both due to HR by Thursday, May 10)

·         Ice Cream Social on May 9, Noon - 2:00 p.m at the Emergency Department entrance and Civiletti Conference Center, and 6 – 7 p.m. and 11 p.m. – midnight, both at the ED entrance. (Ice Cream Socials or gift certificates for off-site locations are being arranged.)  Flavors this year will be vanilla, chocolate, sorbet, sugar free and dairy free. All flavors are kosher.

·         SIM (Simulation) Lab Open House May 9 from 11:00 a.m. to 2:00 p.m. in the South Chapman building.

·         Our annual GBMC Employee Health and Information Fair from 11:00 a.m. to 3:30 p.m. on May 10 in the Civiletti Conference Center.

·         Also, managers will be distributing gifts for all employees during Hospital Week.

Towson Town Festival

This weekend, GBMC will have two booths at the annual Towsontown Spring Festival (Saturday 10 a.m. – 7 p.m. and Sunday 1 p.m. – 7 p.m.).  Stop by and play our “Scratch, win and learn” health questions game.  After you win an instant prize, you can enter to win a raffle for a $50, $100 or $150 gas card. Our double-booth is on upper West Pennsylvania Avenue in spaces 750 and 752.

Nearly New Bargains

This weekend also marks the start of GBMC’s springtime Volunteer Auxiliary Nearly New Sale. Find a bargain, hunt for a treasure, or just shop a little because proceeds benefit patient care at GBMC! Spread the word and please let your friends and family know too.

Sale dates and times:

Employee and Volunteer Day
Friday, May 4, 9:00 a.m. – 5:00 p.m.

Public Day
Saturday, May 5, 9:00 a.m. – 5:00 p.m.

Public Day
Sunday, May 6, 9:00 a.m. – 5:00 p.m.

Public Day
Monday, May 7, 4:00 p.m. – 8:00 p.m.

Half-Price Day
Wednesday, May 9, 4:00 p.m. – 8:00 p.m.

Half-Price Day
Thursday, May 10, 4:00 p.m. – 8:00 p.m.

Bargain Bag Day (Just $5 dollar a bag!)
Saturday, May 12 , 9:00 a.m. – 1:00 p.m.

Congratulations Are In Order     

I wanted to take a minute to call out several units who’ve done an admirable job of patient safety efforts, going at least the past year without a Central Line-Associated Bloodstream Infection. These units were recognized earlier this week at the Leadership conference

Unit 25/26*- (PostPartum)

Unit 27* - (High Risk OB)

Unit 34 - (Express Admission Unit)

Unit 35 - (Acute Care for the Elderly – Geriatrics)

Unit 38 - (PCU – Telemetry)

Unit 39* - Pediatrics Inpatient (Emergency)

Unit 45 - (Oncology)

Unit 48 - (Surgery / GYN)

Unit 54* - (SubAcute)

Unit 58* - (Orthopedics / Spine Center / Neurosurgery)

* Designates unit has not had any CLABSI incidents reported since housewide monitoring began in 2008

GBMC Recognized For Green Efforts

In recognition of GBMC HealthCare’s significant earth-friendly accomplishments, the organization has been named a winner of a Practice Greenhealth Environmental Excellence Partner for Change Award.  GBMC representatives accepted the award earlier this week at the CleanMed 2012 national environmental conference for leaders in health care sustainability in Denver. GBMC has made significant strides in our commitment to sustainability and is committed to maintaining a healthy, sustainable environment, which aligns with our mission of Health. Healing. Hope.  For more details on the award and on what specific earth-friendly steps GBMC has taken, you can read our press release.