Through the End of Life – Celebrating 20 Years of Gilchrist Hospice Care

Last week I had the privilege to attend the 20th anniversary celebration events for Gilchrist Hospice Care. We recognized all that Gilchrist Hospice has done over the years to help see so many individuals and families through the end of life. The care providers at Gilchrist not only provide world class medical care to patients in their final days, but also provide the emotional and spiritual support needed. One of the things that continues to resonate with me as we celebrate the many milestones reached over the past 20 years is how every staff member and volunteer at Gilchrist Hospice has an unwavering dedication to gracefully guiding patients and families in their final journey together.

I was equally impressed and touched by what the keynote speaker had to say about hospice care and a person’s end of life journey. Dr. Ira Byock is one of the nation’s foremost icons in hospice care and he highlighted the fact that death is a personal issue first and a medical issue second. His statement, “We need to take back dying as fundamentally personal and demand much better care for people THROUGH the end of life," was a poignant one. He stressed the notion of THROUGH the end of life rather than AT the end of life and that we should view a person’s final days as the completion of life.

 Dr. Byock, who authored a book about the end of life entitled, The Best Care Possible, stresses the term “dying well” as opposed to “ a good death.” It was fascinating to hear him speak about what it actually means to “die well,” and how important it is to have courageous conversations with individuals and family members about what they truly want when it comes to their own deaths.  For him personally, he talked about a Father’s Day gift that would mean a great deal to him from his two daughters who are in their late 20’s and early 30’s – he told them that the best gift they could give him was to complete their own Advanced Directives.  Each individual certainly views death differently, and many people take personal actions in their last days. For 20 years, Gilchrist Hospice Care has been helping individuals to reflect and take their final actions so that they can “die well.”

Our System and our community are very lucky to have Gilchrist to help individuals complete the circle of life with dignity and on their terms. I congratulate the staff, board members and volunteers of Gilchrist as we reflect on some of the major milestones over the past two decades:

• 1991 - Philanthropist Jeanne “Jinny” Gilchrist Vance makes a multi-million dollar pledge for the construction of a dedicated hospice facility, paving the way for Hospice of Baltimore
• 1994 – Hospice of Baltimore begins serving Baltimore City and Baltimore and Carroll Counties
• 1995 – Ground is broken on the site of the Gilchrist Center for Hospice Care
• 1996 – Gilchrist Center for Hospice Care opens in its Towson location
• 1997 – Hospice of Baltimore merges with Hospice Services of Howard County to serve even more people throughout the state
• 2004 – In 10 years, 10,600 individuals have received hospice care
• 2008 – Hospice of Baltimore is renamed Gilchrist Hospice Care to create a unified name and to honor Jinny’s legacy
• 2009 – Gilchrist Hospice Care partners with Nkoaranga Lutheran Hospice’s hospice and palliative care program in Tanzania
• 2010 - Gilchrist’s pediatric and perinatal hospice program is created and called Gilchrist Kids
• 2011 – Gilchrist Center Howard County opens
• 2011 – Gilchrist Hospice Care receives the prestigious Circle of Life award for innovation in end of life care
• 2012 – Three new programs launch – Music Therapy, End of Life Doula and We Honor Veterans
• 2014 – In the past 20 years, Gilchrist Hospice Care has cared for 40,000 patients and close to 100,000 loved ones

Gilchrist 20th Anniversary Dinner Presentation from Gilchrist Hospice Care on Vimeo.

What is “Meaningful Use?"

In February 2009,  the American Recovery and Reinvestment Act (ARRA) was signed into law.  ARRA was designed to stimulate the economy and to spend money in areas where the country needed investment. One of those areas was in electronic medical records. It is an indictment on our system in the United States that if a citizen arrives in an emergency department the doctors and nurses don’t have complete access to the patient’s medical information. The U.S. was lagging and still lags behind many industrialized countries in the use of electronic records.

$27 billion was set aside through the Health Information Technology for Economic and Clinical Health Act (HITECH Act.) The legislation was initiated in the belief that expanded meaningful use of healthcare information technology would improve quality, safety and reduce health care costs.

This initiative covers both hospital and provider practices and is widely known as Meaningful Use (MU). Our medical center and our employed physicians (GBMA) are both participating, and we have successfully completed two years of Stage I requirements. We are now working on Stage II, which has significantly raised the bar on the electronic clinical documentation and exchange requirements.

GBMC has been working toward a complete electronic health record for many years, long before Meaningful Use was initiated. One of the requirements, Computerized Physician Order Entry (CPOE) was already in wide use when we started working toward Meaningful Use.  Medication reconciliation (checking to see that the patient’s medication list is correct at every transition in care) is another component of MU that GBMC has successfully implemented.

Stage II focuses on Patient Engagement and clinical information exchange for transitions of care.  GBMC will soon be implementing a patient portal for the hospital to complement the existing practice (GBMA) patient portal, known as myGBMC. The new portal will allow patients to access, view and download information about their inpatient stay or ED visit. Another challenge is providing a Continuity of Care Document (CCD) to the provider to whom the patient is referred or the transfer facility at discharge. This has required mapping over 27,000  test codes, procedures and other medical terms to standards that can be universally accepted by other health information systems, as well as changes to the discharge process, and will require providers to use problem lists.

Creating an effective medical record system requires a lot of design and implementation work but it is necessary to drive us closer to our vision. We cannot deliver the care we want for our own loved ones to everyone without electronic records.

Thanks to all who are working to develop and use the electronic patient record. 

Celebrating What Makes GBMC Great During Hospital Week - Our People

As we celebrate Hospital Week, I think about what a great story we have to tell at GBMC HealthCare. Over the past few years, we’ve been moving toward creating standard work and a more reliable system of care. As GBMC approaches its 50th anniversary caring for the health of our community, this week is a great time to reflect on some of the things that make our hospital a great place to come to for care and a great place to work that continues to be a mainstay in the community.

It’s no doubt that our physicians, nurses, techs, therapists, housekeepers, food service workers, maintenance staff, security, volunteers, managers, and all staff members work very hard to continue moving GBMC toward its vision. This past year, our units and departments have made significant strides in creating and improving processes that meet our four aims: Better health, Better care, Least waste and More joy for those providing the care. Leaders and staff throughout the organization have been empowered to execute change.

At GBMC, we believe in being transparent with our quality data, which is updated monthly on gbmc.org/quality. We measure many factors from patient satisfaction to infection rates and I’m happy to say that because of the collective efforts of our teams as well as the commitment to lean daily management, we've seen great improvement in many areas. Take pressure ulcers, for instance – we have gone almost an entire year without a pressure ulcer, which is a tremendous accomplishment.

So, this week, I sincerely thank our employees and everyone who has helped us improve our designs and  make our system of care more reliable and set a course for the future and help meet our vision: to every patient, every time, we will provide the care that we would want for our own loved ones. I truly believe that what makes GBMC exceptional is its people and I’m proud to see the dedication and passion of our team every day.

I invite all employees to take part in the Hospital Week celebrations planned this week including:

• Monday, May 12  - An email from HR Broadcast will be sent out with trivia questions for employees to participate in a drawing for $15 gift cards to Safeway Supermarket. 

• Tuesday, May 13 - An employee gift will be given out May 13 between 8 a.m. - 12 p.m. 

• Wednesday, May 14– Ice cream social! Come hungry:    
• 12 p.m. – 2:00 p.m. in ED entrance and Civiletti Conference Room
• 6 p.m. - 7:00 p.m. - ED entrance 
• 11 p.m. – 12:00 a.m. -  ED entrance 

• Thursday, May 15 - GBMC Employee Health Fair in the Civiletti Conference Center.  The winners of the trivia questions will also be announced on the InfoWeb.

Celebrating Our Extraordinary Nursing Staff During Nurse’s Week 2014

Each year, GBMC celebrates National Nurse’s Week to recognize the outstanding efforts nurses put forth on behalf of their patients. I’ve been at GBMC for almost four years and I have learned how talented and hard working our nurses are. With the introduction of Lean Daily Management, I’ve had the opportunity to meet many more of them and witness first hand their true dedication to our patients and our vision.

Our nursing staff is a phenomenal group – well-trained, caring and resilient. In fact, the resiliency of our nursing staff never ceases to amaze me. Through major snowstorms and torrential downpours, our nurses are there for our patients, whether they have to sleep on cots in the hospital so that they don’t miss a shift, or come in early to make sure shifts are covered.

Our nurses and nursing support technicians are the face of GBMC. They spend the most time with our patients and, in partnership with our physicians, generate the best health outcomes possible. Their untiring work this past year in improving patient safety and redesigning systems to better deliver care has been remarkable.

I’ve talked about some of our excellent nurses in this blog over the past year, highlighting examples of the hard work they have put forth to achieve our four aims including:

• The move toward standard work successfully implemented on Unit 38 by Kim Vohrer and director Justine Kellar, who led their team to dramatic improvements in the reliable use of falls prevention devices for patients at high risk
• Kathy Bull and her team on Unit 35 for implementing the standard work of calling the Emergency Department within 15 minutes of the patient being ready to move to “pull” the patient to their Unit. This new design has had excellent results in reducing the time that an admitted patient waits in the ED
• Charlene Mahoney, the Nurse Manager of the GOR PACU and her team who reached 100% compliance after just two weeks when they decided to measure and enforce the daily completion of the Post Anesthesia Evaluation Note before the patient could leave the PACU as one of their LDM metrics 
• How care managers like Vergie O’Garro in our patient-centered medical homes are effectively helping patients manage chronic health conditions 
• How Kate Devan and her team in the Sherwood Surgical Center are working hard to improve the aim of least waste by moving toward having all cases start on time at 7:30 a.m.
• How our nurses have been working diligently to reduce the rates of pressure ulcers to zero
• The work of Linda Kelly, clinical program manager for SAFE, who was our 2013 Compassionate Caregiver
• Cate O’Connor-Devlin and CJ Marbley, who volunteered their time to get the Playfit program up and running with the kids at West Towson Elementary School to combat childhood obesity

These are just a few examples of how our nursing staff has been getting in action to improve their units and departments as well as the community at large, for the benefit of our patients and all those who come to GBMC for the best care.

GBMC Introduces the Daisy Award for Nursing

Erica Wilkerson

Lindsey Turnbaugh

GBMC has become a proud DAISY Award partner, honoring one nurse every other month with a special recognition. The DAISY Award is an international program that celebrates the extraordinary clinical skill and compassionate care given by nurses every day. The DAISY Foundation was established in 1999 by the family of J. Patrick Barnes who died of complications of the auto-immune disease Idiopathic Thrombocytopenia Purpura (ITP) at the age of 33. (DAISY is an acronym for diseases attacking the immune system.) During Pat’s eight week hospitalization, his family was awestruck by the care and compassion his nurses provided not only to Pat but to everyone in his family.

Nok Ganotong Tongprom

We presented GBMC’s first DAISY award back in November to Erica Wilkerson, RN, the second award to Nok Ganotong Tongprom, RN, in February and most recently, we presented Lindsey Turnbaugh, RN, with the special award in May. All three of these extraordinary nurses showed deep compassion for their patients and embodied our vision – “To every patient, every time, we will provide the care that we would want for our own loved ones."

Thank you to GBMC’s entire nursing staff for everything you do, day in and day out, to help patients in need!

Improving the Patient Belongings System in the Hospital

Do you know someone who lost a personal item in a hospital?  Hospitals around the country misplace thousands of articles every year from eyeglasses, dentures, and hearing aids to favorite sweaters and a myriad of other belongings. I have been at many places that tried to fix this. Think of one typical trajectory of a patient in a typical hospital: from the Emergency Department to the Operating Room to the PACU to the ICU to a floor bed and finally home, and then think of all of the places that the items could get lost.

Keeping the patient’s belongings in a safe place and knowing where they are at all times requires more than hard work and good intentions alone…it requires a designed system and standard work. We have standard procedures for documenting and taking certain belongings from the patient but we don’t always follow our design. But now there is hope…

I have written about our wonderful Unit 36 before. Unit 36 is a Med-Psych unit and some of its patients are at risk of injuring themselves or others. For this reason, it is critical that the staff knows exactly what belongings the patients have access to. Unit 36 began to participate in Lean Daily Management last month and they chose to measure the compliance with our patient belongings procedure as something to study and improve. They have now been measuring this daily and have not only improved their own performance but have also begun to work with other units to improve theirs.

Last Sunday, Nancy Amann-Santos,  the Unit 36 Nurse Manager, held the monthly Clinical Unit Coordinators’ (CUC) meeting on the Unit. CUC’s Nicole Stuckey, Rachel Price, and Christina Mosner realized that they had an opportunity to improve their performance in storing belongings on the Unit so they decided to do a 5S (sort, separate, shine, standardize, and sustain) on the room where the belongings are kept.

This is a BEFORE photo of storing belongings...

The CUC’s worked together to clean, organize and label the room to have an organized and standard process for receiving and storing patient belongings. This was to not only reinforce a need for a safe environment but to ensure that patients were leaving the hospital with the belongings they came with.

The AFTER photo of storage for patient belongings...

What a difference! I am very proud of Nancy and her team and grateful for all that they are doing to move us closer to our vision. After all, if it were your loved one you would want her safe and you would also want her to come home with her glasses and her favorite sweater!

The Creation of a New Playground in a GBMA Neighborhood: Perry Hall

There is an outstanding new playground and amphitheater coming to Perry Hall in the Spring of 2015. It will be one-of-a-kind, community-built, privately and corporately-funded and located next to the Perry Hall Library —a place that promotes active play, stimulates the imagination, is fully accessible and all-inclusive for children, regardless of their physical abilities.  The playground is to be named Angel Park.

The dream of this amazing playground began with an idea that came to Kelli and Andy Szczybor after the loss of their baby boy Ryan. From a sad origin, a bright and life affirming idea emerged – to build a place for laughter, activity and fun for families and friends throughout the surrounding neighborhoods. The playground is being designed with the help of over 2,500 local schoolchildren who shared their drawings and brainstormed ideas.  If you want to learn more about this playground and how you can help, visit  www.angel-park.org. 

The Cost of the Misuse of Prescription Drugs

The ever increasing cost of pharmaceuticals is a major driver of the American healthcare crisis. At GBMC, the cost of pharmaceuticals for our employees has gone up by 13% this year. We see drug expenses rising for many reasons. We are all willing to pay more for drugs that truly generate better health. But what about paying significant amounts of money for drugs that really don’t, or paying for drugs when they actually cause harm?

I am a pediatrician and a fellow of the American Academy of Pediatrics. Last week, I received an alert from the Academy that got my attention. The alert said that the majority of pediatric Clostridium difficile infections, which are bacterial infections that cause severe diarrhea and are potentially life-threatening, occur among children in the general community who recently took antibiotics prescribed in doctors’ offices for other conditions. This came from a new study by the Centers for Disease Control and Prevention (CDC).  The study showed that 71 percent of the cases of C. difficile infection identified among children aged 1 through 17 years were community-associated—that is, not associated with an overnight stay in a healthcare facility. By contrast, two-thirds of C. difficile infections in adults are associated with hospital stays. The CDC has data to show that many patients get prescriptions for antibiotics when the evidence shows that they are not necessary.

The FY 2015 Federal Budget requests funding for CDC for an initiative to reduce outpatient prescribing of antibiotics by up to 20 percent and healthcare-associated C. difficile infections by 50 percent in five years. A 50 percent reduction in healthcare-associated C. difficile infections could save 20,000 lives, prevent 150,000 hospitalizations, and cut more than $2 billion in healthcare costs.

After reading this, I was reflecting on people rushing to Urgent Care Centers and their doctor’s office to get antibiotics, frequently for viral illnesses where the antibiotics don’t actually help. I am curious about what would happen to business at Urgent Care Centers if the rate of antibiotic prescribing went down, as the CDC is trying to encourage. I also wonder if physicians in their offices would have more time to spend with their patients talking about what would actually improve their health if they were not writing so many prescriptions.

It is absolutely clear that antibiotics were a major breakthrough of the twentieth century and that antibiotics improve health and save many lives when they are used appropriately, but doctors, nurse practitioners, pharmacists and patients need to do a better job of making sure that the use of all drugs, but especially antibiotics, follows the evidence.

Beginning the Celebration: Almost 50 Years Old with a Bright Future

This week we kicked off GBMC’s big birthday celebration. Our Healthcare System is nearly 50 years old. Our hospital opened its doors on September 15, 1965 and a dedication ceremony was held on October 2, 1965.  Our HealthCare Board, under the leadership of our Chair, Harry Johnson, Esq., has created a 50th Anniversary Executive Planning Committee. Bonnie Stein, the incoming Board Chair, is the Chair of the Planning Committee.

(L-R): Harry Johnson, Bonnie Stein and Dr. John Chessare kick
off GBMC's 50th anniversary reception.
(Photo by: Maximilian Franz)

The Planning Committee decided to create a Founders Cabinet – a group of people important in the history of GBMC. This group includes community members who helped form GBMC, physicians, past and present GBMC Board members, long-term employees including many nurses, volunteers and donors. The group is inclusive of people from our hospital but also from Gilchrist Hospice Care, Greater Baltimore Medical Associates and private practicing doctors. The Founders Cabinet will guide the celebration and help us reflect on the many wonderful chapters of service to our community in the first 50 years. The Cabinet members will also be ambassadors to the community helping us continue to get the word out that all are welcome in the GBMC family.

So, to kick-off the 18 or so months of celebrating that will culminate on October 2, 2015 with a gala event, the Founders Cabinet gathered together for a reception. It was wonderful to see so many people who have given so much over the years to GBMC and our patients.

The event was organized masterfully by Jenny Coldiron our Vice President for Development and her staff from the Philanthropy Department. After a reception where people chatted and reminisced a bit, Harry opened the proceedings by thanking people for gathering and setting the stage for the evening. I then spoke about how GBMC has been an outstanding hospital and hospice with fantastic physicians, nurses, and other staff. I mentioned a few of our patient success stories and commented briefly on our work to make our care even better. Bonnie then spoke about the work of the Planning Committee and the role of the Cabinet in helping to make the celebrating and reflecting truly come alive in the community.

We then watched a video that had been created by the GBMC Marketing and Communication team under the direction of Interim Director, Greg Shaffer. You have got to watch this video! It beautifully highlights what GBMC means to so many people using the stories of a few key individuals. What a great highlight of a wonderful evening to commence GBMC’s big 5-0 birthday party!



GBMC is made up of so many employees and volunteers who have been an integral part of GBMC’s past, and so many more staff members who are a part of our future. I thank all of our team members for playing a role in caring for our community for close to five decades. I look forward to reflecting on our past and celebrating our future with all of you.