North Bay hospitals are looking at the best ways to meet the mandates of health care reform. One way to increase efficiency is to create affiliations.
As recent legislation has increased the pressure on medical providers to improve health care quality and access, and to expand insurance coverage all while containing costs, North Bay hospitals are looking at the best ways to meet the mandates of reform. One way to increase efficiency is to create affiliations.
Kevin Klockenga, president/CEO of Santa Rosa Memorial Hospital (SRMH), and Evan Rayner, CEO of North Sonoma County Healthcare District, had been talking about forming an affiliation between the two health care organizations for about a year before signing a formal agreement last November. “The goals of this affiliation are really to provide more services locally to our communities and help us each become more efficient, so we can meet the needs of people living in the area while improving the quality of care and number of services we deliver to our patients,” says Klockenga.
The intention is for both hospitals to benefit from the collaboration, but it’s ultimately the patients who’ll have advantages in provision of care and services. Leaders from both organizations began meeting in January 2011 to further discuss ways to work together. SRMH currently has a formal relationship with Petaluma Valley Hospital through the St. Joseph Health System-Sonoma County, but its affiliation with Healdsburg District Hospital (HDH) is different. St. Joseph leases and operates Petaluma Valley Hospital, whereas the affiliation with HDH involves no financial ties.
Both hospitals will continue to operate separately and maintain independent staff and finances. The North Sonoma County Healthcare District owns and runs HDH, and St. Joseph Health System owns and operates SRMH, but “The affiliation provides us with a framework that allows for future collaboration and will help us conserve resources and share best practices,” says Rayner. It also affords the hospitals the opportunity to jointly recruit physicians and integrate clinical systems while looking at ways to reduce patient care costs.
Although each hospital serves patients throughout Sonoma County and beyond (people come from Mendocino and Lake counties as well as from rural areas extending all the way up to the Oregon border), each offers some cutting-edge services more typically found in a University-based hospital or specialty facility set in an urban area.
Santa Rosa Memorial Hospital
As St. Joseph Health System’s flagship in Sonoma County, the 278-bed SRMH is part of an organization that also runs urgent care clinics in Windsor, Santa Rosa and Rohnert Park, mobile medical and dental clinics that circulate throughout the county, and hospice services based in Petaluma, Santa Rosa and Healdsburg. This system is a ministry founded by The Sisters of St. Joseph of Orange, whose members trace their roots back to 17th century France, when a Jesuit priest named Jean-Pierre Medaille organized an order of religious women who would venture out into the community and minister to the needs of the people.
The Sisters of St. Joseph expanded throughout the world and, in 1912, a small contingent traveled from Missouri to Eureka, Calif., to establish a school. The great influenza epidemic of 1918 caused the sisters to branch out from their education efforts to minister to the sick. They realized the tremendous need for a hospital and opened a 28-bed facility in Eureka. The sisters continued on their quest to provide for the ill. Responding to an invitation by Santa Rosa civic leaders, they opened Santa Rosa Memorial Hospital on New Year’s Day 1950.
“We function both as a community hospital and a regional referral center,” says Gary Greensweig, DO, chief medical officer for St. Joseph Health System-Sonoma County. “We focus on clinical excellence that begins with care at the bedside and marry this with highly technical instrumentation to create what we believe is the best possible environment to provide the highest quality in terms of patient outcomes.”
Level II trauma center
As the Level II Trauma Center serving Sonoma, Mendocino, Lake, Napa and northern Marin counties, Santa Rosa Memorial Hospital treats an average of 1,450 patients annually who have suffered serious or life-threatening injuries. On average, the SRMH emergency department treats 100 patients per day. In fiscal year 2010 (July 1, 2009 through June 30, 2010), the department cared for 38,925 patients.
Every three years, SRMH voluntarily undergoes a comprehensive reverification review by the committee on trauma of the American College of Surgeons (ACS) to ensure it’s maintaining the highest standards in patient care and safety. The trauma program began in 1998 and the most recent re-verification was awarded in May 2009 following an onsite visit from independent ACS surveyors. SRMH was designated as the regional level II trauma center in 2000, a designation renewed by Sonoma County and Emergency Medical Services (EMS) officials in 2010. Since 2000, the hospital has treated more than 14,000 trauma patients.
Being a level II trauma center means patients have 24/7 access to trauma surgeons, emergency physicians, anesthesiologists, neurosurgeons and orthopedic specialists. At SRMH, they also can use numerous onsite clinical resources such as interventional radiology and inpatient acute rehabilitation. The hospital also has a helipad and receives patients from a five-county area via rapid emergency air transportation for immediate response.
Heart and vascular institute
The Centers for Disease Control and Prevention lists heart disease as the number one cause of death in the United States and ranked stroke as the third-leading cause of death. It’s no wonder that SRMH chose to focus its efforts on creating state-of-the art centers to assist patients who suffer from heart disease or strokes.
The $57 million Norma and Evert Person Heart & Vascular Institute opened in 2009, with $16 million of the capital raised through private donations. With a door-to-balloon time (the amount of time between a heart attack patient’s arrival at the hospital and when he/she receives percutaneous coronary intervention, or PCI, such as angioplasty) averaging 62 to 65 minutes, SRMH is well below the national standard of 90 minutes. The average door-to-balloon time for similar hospitals is 87.9 minutes. SRMH has the highest-ranking average out of the 949 hospitals in the United States that have cardiovascular teams tracked by the American College of Cardiology Foundation’s National Cardiovascular Data Registry.
Primary stroke certification
The Joint Commission on Accreditation for Healthcare Organizations (JCAHO) certified SRMH as a Primary Stroke Center last November. The approval signifies that the services offered at SRMH include critical elements needed for stroke patients to achieve long-term success in improving their outcomes.
The stroke center at SRMH provides an around-the-clock, rapid response team to treat stroke patients. Physicians and nurses specializing in neurology, neurosurgery, neuroradiology, emergency medicine, physiatry and endovascular and vascular surgery are all available to determine the best treatment option for every patient. “Stroke is the number one cause of disability and the number three cause of death for people living in the United States,” says Christo Brockway, RN, MS, HCA, stroke center clinical coordinator and program manager.
“Properly diagnosing the reason for a stroke can often help us prevent a second stroke from occurring,” says Brockway. Since more than 50 percent of stroke patients have underlying cardiovascular problems, having both a heart and vascular institute and a stroke center under one roof provides patients access to highly coordinated services for both inpatient and outpatient services, something that’s unique to Sonoma County.
A distinctive feature of the center is the provision of onsite acute rehabilitation for inpatients and neuro rehabilitation for out-patients. The stroke center and comprehensive rehabilitation center is the only such model in the region. “It’s often hard for patients to get to the city and it’s difficult for family and friends to visit and learn to assist them when they’re in rehab,” says Brockway. At the SRMH facility, accommodations are made on the night before a patient checks out for a family or friend to stay with them for 24 hours to learn how to properly care for the patient.
Therapeutic endoscopy and endoscopic ultrasound
Sahar Ghassemi, MD, is a gastroenterologist who’s board certified in gastroenterology and internal medicine. The Yale School of Medicine graduate was recruited by SRMH because of her experience using endoscopic ultrasound (EUS) as a tool to detect and treat gastrointestinal cancers. In addition to her gastroen-terology fellowship at Yale, Ghassemi completed an additional year of subspecialist fellowship training for the EUS and therapeutic endoscopy at the University of Oregon.
“It’s gratifying to use my training to provide the most meaningful and highest quality care for my patients,” says Ghassemi. SRMH offers coastal California’s only EUS services north of Marin. Ghassemi notes that the procedure is minimally invasive and very low-risk with an incredibly high yield. The equipment can help her determine how deep and involved a tumor is. “A CT scan is more like a satellite view. EUS helps an oncologist get a more local and close-up view and can help determine whether a patient’s next steps should involve surgery or an alternative method of treatment.”
She’s found that one population that’s benefited greatly from her local services is the elderly. She recently treated an older woman whose husband was nervous about driving his wife to San Francisco to be treated. Having the service available locally enabled the woman to receive EUS in Santa Rosa where the couple could come during daylight hours without having to make a long trip to the city.
Intensive care nursery using Skype
SRMH was recently featured in the American Academy of Pediatrics newsbriefs for its innovative use of Skype in its UCSF intensive care nursery (ICN). It’s well documented that, in cases of an early separation between a mother and newborn, there’s an increased chance of parental anxiety, postpartum depression, decreased bonding and a potential for problems in the relationship between parents. Using a webcam, ICN staff can send a video feed to a parent’s or family member’s laptop computer, helping new parents bond with their child when they can’t be physically present with their infant.
Healdsburg District Hospital
HDH’s main facility entryway is small and cozy—but don’t let the homey atmosphere fool you. This 43-bed acute care facility serves more than 60,000 residents, from Windsor to Cloverdale and part way to the Sonoma Coast. The hospital also operates a clinic in Healdsburg for wound care, physical therapy and women’s diagnostic care, a Cloverdale lab and physical therapy clinic and a Windsor lab. It also has a strong Ayudante Program to help Spanish speakers as well as access to translation services for 148 languages.
Northern California wound care center
HDH’s hyperbaric oxygen therapy (HBOT) program started in August 2010. The two hyperbaric chambers at the Northern California wound care center are the only ones north of San Francisco dedicated to providing comprehensive treatment using advanced wound care modalities. Its use is approved by Medicare, the American Diabetes Association, the Wound Healing Society, Blue Cross and most insurance carriers. Some of the most common medical indications for HBOT include diabetic foot ulcers that won’t heal, injury caused by radiation treatment and long-standing bone infections. Tom Briones, a certified hyperbaric technician, says they’re the same type of chambers used for deep sea divers who get the bends.
“This manner of care lets us offer patients the best chance to heal a problem wound,” says Dan Rose, MD, medical director of the center. “Patients lie in a clear, ‘tube- like’ chamber where they experience a change in atmosphere, much like the experience of scuba diving. Two atmospheres is equivalent to a depth of 33 feet, and some patients may even require three atmospheres. Then 100 percent oxygen is pumped in. The oxygen causes white blood cells to be more active and increases their ability to fight infection. This treatment dramatically increases a severe wound patient’s ability to heal,” explains Rose.
Telemedicine robot
Chances are, if you find yourself in the ICU, you might have a visit from Syd, the resident telemedicine robot. Syd is well-known throughout the HDH halls, where, since 2007, his five foot tall motorized frame has been frequently seen roving via remote control or being pushed by a staff member from the ICU to the emergency department and back (HDH was the first critical access hospital in California to use it). Telemedicine robots, such as Syd, afford doctors in smaller rural hospitals the ability to electronically transmit medical data in real time through the use of video and a range of diagnostic tools.
Consulting intensivists and other specialists are ready on the other end to assist in patient treatment. A two-way camera is mounted to the robot and allows for a visual inspection of and interaction with the patient. A stethoscope on the back of the robot is used for auscultation. More detailed examinations of the patient’s heart, lungs, abdomen and major vessels are performed with ultrasound equipment attached to the robot. Doctors can also share electronic or faxed medical records, electronically transmitted X-rays, CT scans and MRIs to help analyze a patient’s condition, and can link with existing EMRs (electronic medical records). After discussing the diagnosis with the referring physician, the intensivist emails or faxes evidence-based protocols and order sets to the ICU and continues to follow the patient as requested.
“It provides a crucial lifeline for our patients,” says Connie Whitemore, RN, and ICU nurse manager who’s been trained to operate and assist physicians who want to use Syd. Specialists in cardiology, pulmonology, psychiatry, dermatology, oncology, infectious diseases, neurology, nephrology (kidneys), gastroenterology and pediatrics are all available and can be brought up live, onscreen, within two minutes. Whenever assistance is needed in one of these areas, the intensivist contacts the appropriate specialist, who then performs a remote consult via laptop computer. “Patients really like Syd. They find it reassuring to have a specialist by their side,” says Whitemore.
Smaller hospitals could never afford to keep such specialists on as full-time staff members. Syd gives them access to life-saving expertise at an affordable cost. Palm Drive Hospital in Sebastopol also employs a telemedicine robot, and sometimes the two hospitals communicate via their robots.
Whitemore has another connection to the advanced technology offered by HDH. Her father was the first candidate to use the wound care center’s hyperbaric chambers. With a non-healing diabetic ulcer, a wound on his foot had already caused her father to have part of his toe amputated. As a result of hyperbaric treatment, his wound healed and the remainder of his foot was saved from removal.
Pursuing stroke certification
In January 2009, HDH opened the Kozel Stroke Institute, named for long-time Healdsburg residents Ed and Betty Kozel, who helped fund the center. The American Stroke Association states that getting treatment within three hours of the onset of symptoms may mean the difference between walking again or being permanently disabled.
In keeping with its mission to provide quality care close to home, HDH uses its telemedicine robot (Syd) to bring a neurologist’s expertise right to the patient’s bedside within minutes, anytime, day or night. Proper and immediate care is crucial, since strokes carry the potential of death or severe disability when left untreated. All of the nurses participating in the program have taken stroke courses, and the staff is working to complete the other necessary steps to become a stroke-certified care center.
Improving outcomes locally
Local access to advanced medical care services are now being made possible through highly sophisticated technologies. Meeting people’s health needs in their own community means time and resources saved. Affiliations such as the one between SRMH and HDH can promote better coordination of medical services and cut costs. Perhaps the most important provision is that collaboration improves patient care—something even those who weren’t in favor of health care reform can agree is important.
