The rearview mirror and the road ahead

Innovation, program growth, new educational programs, new research projects and measurable progress in quality of care marked 2013 as another year of achievement for our medical staff.  What follows is at most a partial list. 

As the NSLIJ Health System announced the repurposing of Glen Cove Hospital in 2014, physician leaders came together to create a future home at Huntington for their well-established Family Practice Residency.  Dr. William Bennett joined our Medical Staff to continue the program leadership that he carried out for three decades at Glen Cove, working with our Hospitalists, Intensivists, Palliative Medicine, Surgery, Pediatrics and Emergency Medicine staff to weave together a truly top flight graduate program.  More to follow!  At the same time, the School of Medicine continues to grow, and with it the Introductory Clinical Experience (ICE) course which is currently served by more than fifty Huntington physician preceptors.

Surgical services grew with the addition of Dr. Marinel Ardeljan to the Department of Surgery (Section of General Surgery). Dr. David Rivadeniera joined our staff as Director of Colorectal Surgery and built what can already be described as a thriving colorectal service. Drs. Vijay Singh and Lawrence ("Larry") Glassman, meanwhile, significantly increased the scope of thoracic services including robotic procedures.  And speaking of robots, we did acquire the DaVinci robot and your colleagues used it to perform over 300 procedures to date - with excellent outcomes - in fields including gynecology, urology, bariatrics, general surgery and, as mentioned, thoracic.  All this occurred under the close supervision of the surgical leadership with Dr. Ted Goldman chairing a new quality committee known as the "Robotic and Minimally Invasive Surgical PICG."

Hospital readmission rates fell during 2013 and by year's end HF-specific readmission rates were the third lowest in our Health System.  (This complex measure is driven by a host of factors, including patient education, the promptness of post-hospital followup and especially the utilization of palliative resources in patients with end-stage disease.  More on that below.)

Sepsis is responsible for more than 200,000 deaths a year in the US alone and experts believe that a large fraction are preventable with early goal-directed therapy. Our sepsis care was very strong this year, with the hospital's Risk-adjusted Sepsis Mortality Index coming in 15% lower than the System-wide overall result.  Physician-led teams implemented protocols to ensure prompt administration of fluids and initial antibiotics and this goal was achieved 93% of the time, placing us in third place System-wide.  Credit for this work goes to Drs. Stratemeier (ED), Diblasio (ICU), Hoey (ID) and Pawar (Hospital Medicine) with strong support from Nursing and Quality Management. 

All-cause mortality is measured and publicly reported as a "risk-adjusted index" (with 1.0 by convention representing the national mean).  With an index 10% lower than the System-wide metric, Huntington continued to lead performance in our Health System for most of 2013, outperformed at year's end only by Lenox Hill Hospital. 

Mortality rates reflect quality in three ways.  Optimally communicating in and documenting on the medical record means that the hospital recieves "credit" for the patient's acuity.  Additionally, appropriate use of end-of-life services (Palliative care and Hospice) means that fewer patients die in the ICU or other in-patient settings.  This is good care and is reflected favorably in the mortality metric.  Finally, and most important, prevention of hospital mortality means working on many aspects of care, reducing medication errors and healthcare-associated infections while increasing our sensitivity to signs of instability and "rescuing" patients with treatable causes of decompensation. 

Finally, the medical staff adopted and adapted to (nearly) universal CPOE.  This was painful and frustrating, and no, we didn't have enough resources to do it "right" and yes, the communication can always be better.  But our physicians did what needed to be done to take care of patients.  Which is why we're all here.

I was going to talk about some priorities for 2014, but this post is too long already.  So stay tuned for part two.  In the meantime, my very warmest wishes to all of you for a healthy, productive and personally satisfying 2014.

 
   

Happy New Year! Introducing a New Blog for Our Medical Staff

The EMR.  Changing employment relationships.  CMS mandates.  And did I mention the EMR…so many challenges seemed to be aimed at the practicing physician that have so little to do with why we entered the profession in the first place.  Despite these obstacles, I am proud to say that Huntington Hospital physicians continue to raise the bar on clinical performance, quality of care, patient safety, medical education and research.  

We are a professionally diverse group >> While some of us are performing technologically-advanced procedures, others are toiling in the fields of primary care, creating (as we are at the Dolan Family Health Center) the Patient-centered Medical Home.  We are generalists and specialists and consultants, focusing on every part of the bio-psycho-social continuum of care.  


The sole purpose of this new blog is to create a space for multidirectional conversation about matters of broad interest to you, the members of our Medical Staff.   Since it's "my" blog technically, I am committing to keep the dialogue going.  However, I am relying on you to suggest new topics, raise concerns, respond to your colleagues' and my own posts, and from time to time share your successes.*  In other words, I appeal to you to USE the "Comment" button!

*Needless to say, there are SOME limitations here.  I chose to launch this blog on blogspot.com so we could all get to it easily and have the functionality of a real blog.  Meaning that I COULD have launched this inside our Physician PORTAL but didn't, even though PORTAL would have provided more privacy.  So no PHI of course, and no comments that you wouldn't want someone to find by Googling your name.