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.

Congratulations!!
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!

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!

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!

Another First for GBMC

Science has taught us how to save individuals who are having a life threatening cardiac arrythmia. We also know that time is of the essence, so being well-trained in advance leads to better outcomes for the patients. 

Recently, GBMC became the first hospital in the state of Maryland to earn the designation as an RQI Lighthouse Organization because of our “adoption and consistent use of an innovative CPR training program.” We are the first hospital in our state to use the RQI system to train nurses and other clinical providers in cardiopulmonary resuscitation.

RQI training techniques have helped members of our clinical staff achieve sustained mastery of CPR skills. The hospital implemented the system, which is endorsed by the American Heart Association, back in 2016. During the training, the system provides live feedback, while the learner practices CPR skills with a manikin every three months.  These techniques came in handy a couple of years ago when one of our own staff members used his skills outside of a patient unit to save someone’s life.

While walking to lunch, Roel Tiberio, BSN, RN, CGRN, Endoscopy Nurse Manager with The Kroh Center for Digestive Disorders and one of our Art of Nursing Award recipients,  was having a conversation with a coworker when he heard a loud noise and turned to see that someone had fallen.  At the same time, two other GBMC HealthCare system medical staff members were leaving the cafeteria, and also saw the visitor on the floor.  They immediately ran to assist and found this person to be without a pulse and not breathing. Using his clinical training, Roel quickly delegated someone to call for a code and another to get an automatic external defibrillator (AED) while he began CPR. Roel followed the instructions which indicated that the visitor required a shock.  Roel proceeded to shock the patient as he and his colleagues continued CPR. When the code team arrived, the visitor was breathing on his own and was immediately transported to the Emergency Department.  After a full medical assessment, the patient was admitted for observation. Roel was relieved to learn that the patient had survived without complications.  

It is not uncommon for our clinicians to implement CPR on a patient, but it is not often that clinicians use these skills outside of patient care units. Roel’s quick actions were lifesaving and clearly shows the value of the RQI system. 

I want to thank Vanessa Velez, Director of Professional Practice, Education, and Research at GBMC HealthCare and Deborah Higgins, MS, RN, CHSE, our Simulation Manager and AHA Training Center Coordinator, for all their hard work to make sure that we are adopting best practices and continually improving our readiness for events like the one described above. I would also like to thank David Vitberg, MD, Director of our Medical and Surgical ICU, and Carolyn Candiello, our Vice President for Quality and Patient Safety, for working with RQI to bring this tool to our hospital.   

Diversity & Inclusion Assessment
Our vision at GBMC HealthCare is to become the community-based healthcare system that can deliver to every patient, every time the care we would want for our own loved ones.

We cannot achieve this vision unless our workforce mirrors those we are serving. Our diversity brings more new ideas and our inclusiveness magnifies this by empowering many more people to innovate. We need our entire team to be engaged to move us forward, faster. 

GBMC will be working with Cee Suite to conduct an assessment of the current state of Diversity, Equity, Inclusion & Accessibility in the GBMC HealthCare System. This assessment will help our organization identify what we are doing well and where we can improve. Cee Suite is a talent management consulting firm with a specialized focus in diversity, equity, and inclusion. They partner with organizations to develop sustainable DEI solutions.

After completing the organizational assessment, Cee Suite will provide leaders at GBMC with a roadmap to create a more diverse workforce and foster an inclusive environment for our staff and patients.

What should you expect?

--In the next 30 days, employees from various departments, roles, and backgrounds will be invited to participate in focus groups led by Cee Suite.  This participation will require a commitment of one hour.
--Over the next 3 to 6 months, we will share the feedback from the organizational assessment and an introduction to our organizational plan. 

If you have questions regarding this initiative, please send them to diversity@gbmc.org

Thank you.

The Maryland Waiver with the Centers for Medicare and Medicaid Innovation

It is a very complex topic, but readers of the blog know that the State of Maryland has an all-payer rate setting system. In Maryland, unlike in the other 49 states, hospital payments for services are determined by the Health Services Cost Review Commission (HSCRC), a quasi-governmental agency. In the rest of the country, hospitals negotiate payment rates with insurance companies and are told what the rates are by Medicare and Medicaid. Stand-alone hospitals, like GBMC, have little bargaining power in other states, so they are usually paid less than hospitals run by large companies. In Maryland, all payers, including Medicare and Medicaid, pay the same rate to the same hospital for the same service, and these rates are set by the HSCRC. In other states, Medicare usually pays below what private insurers pay and Medicaid significantly below what private insurers pay. GBMC gets paid less than many of the hospitals in our region for the same service, but we are protected by the all-payer rate setting system.

Recently, the Centers for Medicare and Medicaid Services (CMS) published an evaluation of the first two years of the Maryland Total Cost of Care Model. Since January 1, 2019, CMS has been holding Maryland accountable for reducing the total cost of care for Maryland Medicare beneficiaries, not just for hospital costs, while improving the quality of care and patient satisfaction. The evaluation points out that Maryland reduced total Medicare spending in 2019 (relative to national trends) by $365 million — $88 million more than the spending reduction achieved in 2018, which followed the previous waiver model. The report concluded that global budgets remain the biggest financial incentive in the Model. 

Maryland has also embarked on a new program to incentivize better primary care called the Maryland Primary Care Program (MDPCP). The report says that primary care practices in 2019 made gains in the targeted domains: access and continuity, care management, comprehensiveness and care coordination, patient and caregiver engagement, and planned care. Blog readers know that advanced primary care is a fundamental building block of the GBMC HealthCare System, so you won’t be surprised to know that we are among the leaders in MDPCP.

It will also come as no surprise that our GBMC Health Partners primary care providers were recently acknowledged by readers of The Sun as the best in the Best General Practitioner (primary care) category. It’s nice to see that members of the community now understand that we are different and validate our excellence as we move towards our vision of being a community-based system of care that can deliver to every patient, every time the care that we would want for our own loved ones. 

Readers of The Sun did not stop the accolades with primary care. They also found GBMC to be the Best Hospital in our region! Our Audiologists were also found to be the best!

And we had others recognized as runners-up in the following: 

• Best OB/GYN Practice

• Best Audiologist - Presbyterian Board of Governors Cochlear Implant Center of Excellence

• Best Pediatric Practice - GBMC Pediatric Group

I want to THANK the community for their support and all who voted for recognizing the hard work and dedication of our people.

Way to go!
I would also like to announce that Baltimore's Child Magazine recently unveiled its list of 2021 Readers’ Choice winners. GBMC was named: 

• Best Hospital - Hometown Heroes - COVID-19 Pandemic Response

• Best Place to Deliver Your Baby

• Best Pediatric Vision Care - Dr. Allison Jensen, Eye Center at GBMC

And runners-up in the following: 

• Best Pediatric Physician - Hometown Heroes - COVID-19 Pandemic Response, Dr. Theresa Nguyen - GBMC Pediatric Group

• Best Medical Matters

• Best ER for Kids

Congratulations to Drs. Jensen and Nguyen. I am very grateful for everyone who has made this recognition possible.

Congratulations!
It is no secret that those of us in the medical field never stop taking care of people even when we’re not at work. David Vitberg, MD, Director, Division of Medical and Surgical Critical Care Medicine, is a perfect example.  

Recently, Dr. Vitberg was awarded the Maryland Star of Life Award for his heroic efforts to save a man who was trapped under a waterfall in Rocks State Park. The award, presented by the Maryland Institute for Emergency Medical Services Systems (MIEMSS), combines the organization’s symbol, the Star of Life, with its shared vision, “the elimination of preventable death and disability from injury or sudden illness.”

Dr. Vitberg, along with first responders and other EMS physicians, played an instrumental role and worked for hours to free a man – nearly having to amputate his leg. Fortunately, the water rescue team was able pull him out just prior to the procedure. The man was treated on the scene and then transferred to a local hospital with his leg intact.

We are all incredibly honored to have Dr. Vitberg as a leader at GBMC and congratulate him for this award! 

Getting Ready for the Construction on our Campus

Back in June, I talked about some changes that were forthcoming in terms of parking and other closures to accommodate the beginning of construction for the three-story addition, the new parking garage and the new Sandra R. Berman Pavilion, called The Promise Project. As we inch closer to our official groundbreaking on September 2, you will be hearing a lot more about this project, and we will work hard to keep you as informed as possible about the construction process and how it will affect employee workflow, visitors and patient access. 

The Rose Lot will close as of this Monday, July 19. This is necessary because the heavy construction equipment will park in this area, and it will also be a staging area for construction. Reducing parking spots makes people concerned about their ability to find a place to park. Tulip and Lily garages have abundant space to handle those who will no longer be able to park in the Rose Lot. And actually, the Lily Garage is closer to the main entrance and has a conditioned walking path to protect employees, patients and visitors from the elements. 

Thank you for your patience as we continue the repairs to the Daffodil Garage. From July 12 through October 1, we will be working on Levels 1 and 2 of the garage, affecting 60 total parking spaces. The garage will remain open, but we are asking employees to park in the Tulip and leave the remaining spots for patients and visitors. We are also adding a valet attendant on July 19 and will add another valet station at the former Sherwood Loop in early August to help with access and flow. 

Lastly, Human Resources has relocated! As of this week, nearly all Human Resources employees are working in the South Chapman Building. If employees have any concerns, questions, or are looking for anyone in particular, your HR business partner is a great place to start, but you are always welcome to visit South Chapman to find what you need. 

New Date for Employee and Volunteer BBQ

I would not want to miss an opportunity to thank and acknowledge our amazing employees, especially after the challenging year we have had. We have traditionally held our annual Employee and Volunteer Appreciation BBQ in July, but this year we are moving it to Thursday, September 30. More details are forthcoming, and I hope every employee plans to attend. This year was tough and threw us many curveballs. Each one of you handled it with grace, humility, and always with a focus on the patient. I look forward to celebrating with you on September 30. 

Congratulations and Thank You

Our triennial survey by the Joint Commission was completed last week and we did very well. I was not surprised because we have outstanding people and we have worked hard to create systems to help them do their job and provide highly reliable care. Let me thank all our team for their incredible efforts to deliver the care that we want for our own loved ones. Great job!

The surveyors found some opportunities for improvement but overall, they were very impressed. In many areas, they had no findings. In Maternal Newborn Health (MNH) the nurse surveyor from the Joint Commission reviewed eight charts and found no issues to correct!

Every Joint Commission visit to MNH starts with the review of a patient who has had a vaginal delivery and one who has had a cesarean section. There is also a chart review of a high-risk patient with an obstetrical or medical complication.

In 2020, the Joint Commission introduced two new standards to address complications related to maternal hemorrhage and severe hypertension. Our nurses, nurse educators, and Epic analysts worked together as a team to add functionality to Epic to meet the new standards. This was a collaborative process where input from all team members was invaluable. The goal was to assure patient safety and decrease the risk of complications, while ensuring seamless integration with the workflow. The surveyor focused on these new standards during the chart reviews in Labor and Delivery.

During the chart reviews, the Labor and Delivery nurses were able to highlight two new areas of build in Epic that address the new standards. The Labor and Delivery and Mother Baby staff now use a Postpartum Hemorrhage Assessment tool that identifies the patient’s risk of hemorrhage from admission through the postpartum period. One of the highlights of this tool is that once the provider enters the necessary documentation to calculate a hemorrhage risk score on admission, Epic continues to calculate the risk based on specific criteria in the background without the nurse having to re-enter documentation at set intervals. The score recalculates automatically and is highlighted in the Storyboard and several other areas in Epic.

The Labor and Delivery nurses were also able to highlight the care that they provided for a patient with a hypertensive emergency. The Epic team and clinical end users worked together to build a new comprehensive order set for this type of event as well as new patient assessments. The staff did a great job of navigating through this complex patient chart.

I want to congratulate Gretchen Bell, RNC-OB, C-EFM, our Application Coordinator/Analyst Team Lead EPIC, our Labor and Delivery nurses, and all members of our MNH team for this fabulous achievement, and for working together to continually improve patient care.

I also would like to thank everyone for their hard work, collaborative spirit, and commitment to patient safety.  It was evident to our survey team that GBMC is a highly reliable, patient-centered organization.