Friday, August 27, 2021

One Less Factor in Vaccine Hesitancy

Earlier this week, I was delighted to hear the Food and Drug Administration (FDA) granted full approval to Pfizer's COVID-19 vaccine for use in people ages 16 and older. 

It is clear the Pfizer vaccine—along with the Moderna vaccine—is safe, highly effective, and the strongest weapon we have to combat this virus. The FDA had already studied the early data before giving emergency use authorization, and has now gone through its full, rigorous process to grant full approval. The Pfizer vaccine is probably the best studied vaccine in the history of FDA approvals in that hundreds of millions of doses have been given around the world with very few significant side effects. 

This latest surge in COVID-19 patients we are experiencing in emergency rooms, outpatient clinics and hospitals across the nation is primarily due to unvaccinated people. This is very concerning since we are still not sure what the fall will bring with back-to-school activities and the potential spread of COVID-19 among our children. In a recent poll, 30 percent of unvaccinated people said they were holding off on getting the vaccine until the FDA had granted full approval, so we are hopeful this FDA approval will encourage those on the fence to get vaccinated to protect themselves and others.

With the Delta variant surging, there has never been a better time to get vaccinated. GBMC is requiring all GBMC HealthCare employees, contractors, independent medical staff members, volunteers, and learners without a medical or religious exemption to be vaccinated, and we have had to speed up this deadline after the Governor’s mandate that all hospital and nursing home employees be vaccinated by September 1. The GBMC HealthCare community is required to be fully vaccinated, or submit an exemption request, by October 1, 2021.

I want to congratulate our Primary Stroke Center which, under the leadership of Ellen Deibert MD, FAHA, Medical Director of our Stroke Center and our Chief of the Division of Neurology, and Aaliyah Franks, RN, recently achieved the 2021 American Heart Association’s (AHA) Get With The Guidelines® (GWTG)-Stroke: Gold Plus with Target: Stroke Elite Honor Roll and Target: Type 2 Diabetes Honor Roll. 

These awards recognize hospitals that meet specific quality measures for the diagnosis and treatment of stroke patients. Despite challenges in the last 18 months presented by the pandemic and a cyberattack, the Primary Stroke Center has been able to maintain extraordinary award levels with the American Heart Association for stroke and diabetic stroke patients.

The awards are a testament to our Stroke Center’s strong commitment to reliably provide care according to nationally recognized guidelines built on the latest scientific evidence.

I want to thank all our clinicians for their hard work and dedication in achieving this level of performance. Great work and congratulations!

Friday, August 20, 2021

More Changes on Our Campus

This week I want to provide you with another update about campus changes as we begin construction on The Promise Project

In June, we began with the creation of a temporary main entrance (until the new addition is complete) and we then continued with the closing of the Rose parking lot to address the need for a staging area for construction. 

On Monday, August 23, the main entrance of our hospital will close, and we will begin using the temporary main entrance in the Sherwood loop.  Since the three-story addition will be built in front of our current main entrance, we need to close it now. As we cordon off space in front of the main entrance, we will lose some handicapped parking spots. We have taken a number of steps to limit inconvenience to our staff and patients.

We have added another valet parking location (we added a valet attendant by the Daffodil garage last month) at the Sherwood loop. We have also added additional handicap spaces in the Sherwood Loop area and in our Lily Parking Garage. There are also additional wheelchairs and dedicated transporters to serve our patients and visitors with mobility issues. We recommend that our patients utilize the Tulip and Lily garages since they have abundant parking spaces. As I have pointed out in the past, the Lily Garage is closer to the main entrance than the Rose lot and is connected to the hospital to protect employees, patients, and visitors from the elements.
We have set aside many parking spots for our patients. Most of our staff have refrained from parking in those spots and historically we have not enforced our no-staff parking rule in patient spots. Sadly, some of our people have been parking in patient-only spots so now we have begun to enforce the rule.
In order to make it easier for folks to get around the campus, we added a new shuttle bus this past Monday. Current drop-off and pick-up locations include: the William E. Kahlert Physicians Pavilion North, Farmhouse Hill, Physicians Pavilion West Main Entrance, and the Sherwood loop.  Stops are every 15 minutes from 6:30 a.m. to 7:00 p.m. on weekdays.

The first two levels at our Daffodil Garage will remain closed until October 31. The garage is open for our patients, but we are asking staff to park in the Tulip garage. Thank you to all for your patience as we continue the repairs. 

Lastly, our new Ambulatory Imaging Center will open in mid-September in Physicians Pavilion East at the former location of the Kroh Center for Digestive Disorders.

The official groundbreaking for the Promise Project will occur on Thursday, Sept. 2. We will continue to update you on necessary changes to the campus as the construction progresses. 

Thank you!

Thursday, August 5, 2021

Outstanding Redesign Work in the Emergency Department

In the early 20th century, as medical care was progressing, and therapies became available that actually improved patient outcomes (like antibiotics and sophisticated surgical procedures), the Emergency Room became the place to go for serious injuries or acute medical problems. Later in the century, as medical care became more complex, and there was more specialization in medicine, the Emergency Department (ED) became a sort of “catch all” for anything that couldn’t be handled anywhere else in the system. If the doctor’s office was closed or the doctor was already too busy, patients were sent to the ED for real needs that were not truly emergencies. In 1965, with the advent of Medicaid and payments below what private practicing doctors would accept to cover the costs of running their practices, ED’s became the place where poor people went for care, not because they wanted to be there for non-emergencies, but because many doctor’s offices would not accept Medicaid. And finally, the aging of the population is another reason  Emergency Departments here, and around the country,  continue to be in high demand.

For the last few decades, ED’s have been under siege. The professionals working there are incredibly dedicated and well-trained. They work extremely  hard, but the system is not designed for efficient flow. 

The GBMC ED is operating under the same stressful situation as other ED’s. We, however,  have an advantage over most ED’s --  outstanding leadership. Dr. Jeff Sternlicht, Medical Director, and Mark Fisher, RN, Nurse Manager, have fully embraced our vision and have become quite proficient at redesign. With the help of our performance improvement advisors, they have redesigned much of the care of ED patients who don’t need to be admitted to the hospital.

There are three areas to focus on to improve patient flow in the ED:

1. Input: You can work to make sure that only patients with emergencies come to the ED. (This is the work of primary care, specialty physician offices, and other community providers.)

2. Throughput: You can work to reduce waste in the processes from check-in to discharge home. (Clearly the work of the ED team.)

3. Output: You can move patients to an inpatient bed as quickly as possible once you know they need to be admitted. (This is the work of the inpatient teams led by our hospitalists or inpatient specialists.)

Jeff and Mark have been happy to work with our patient-centered medical homes on reducing non-emergent visits and to work with our Department of Medicine in particular, to move admitted patients to the floor faster.  They have not wasted any time  getting in action to redesign the work of assessing and treating those who they think can be sent home – the throughput work. 

So, what have they done so far? 

Redesign of Triage:  They added a medical provider in triage to connect the patient to a provider sooner. This is allowing the Emergency Department to start care on entry, during busier times of the day. 

Implementing a Protocol Bay: This allows labs and IVs to be started right after triage. This gets blood sent to the lab sooner and test results back quicker for patients even before they get to a treatment space.

Implementing a Rapid Assessment Zone: This allows patients with lower acuity needs to have their care started in the waiting room even before they get to a formal treatment bed.

Yesterday on our Lean Management System rounds, Katie Koestler, RN4, presented the ED’s results so far. I am so proud of Jeff, Mark, and their team. They are doing phenomenal redesign work and moving us faster toward our vision. They are clearly improving the care experience and reducing wasted time in the ED. Please thank the members of the ED team when you see them!