From the CMO Corner: CMO Reflections

Corporate Visit

As many of you probably know, our group president, group chief financial officer, and the executive administrative team from the Division spent two days on site in February.

Overall, they were very complimentary of the progress we have all made together around improving the care and experience for our patients in the facility, especially given the much more difficult economic environment in the state in 2017. They also challenged us to continue to look for ways to engage and collaborate with physicians and staff around care quality and patient safety as well as improving throughput and operations at the facility. Over the next several months, we will bring forward ideas and opportunities for your consideration, and we hope that as members of the medical staff, you can assist us in further improving yours and your patients’ experience at the hospital.

Finally, as part of the visit, the corporate team dedicated capital for the following improvements:

• A new 64-slice CT scan unit with a bariatric table and larger gantry
• Upgrades to our Zeiss microscope in the OR in order to facilitate complex cranial cases
• Purchase and install of an O-arm and upgraded Stealth unit in order to increase options to treat complex spinal surgery patients
• The purchase of two rapid infuser units to replace our current outdated equipment
• Complete equipment replacement in all three cath labs with state-of-the-art Phillips units that will expand our ability to provide safe and complex cardiac and endovascular care
• CCU bed replacements and replacements of outdated stretchers in the PACU/OR units

Opioid Reduction Strategy

As most of you are aware, healthcare providers across the country, as well as hospitals and physicians alike, are in the crosshairs regarding the high opioid utilization rates in the United States. Fairly or unfairly, providers are increasingly being blamed for the tremendous addiction problem, particularly in relation to highly potent synthetic narcotics such as hydrocodone, oxycodone, and OxyContin.

It is now incumbent upon all of us to work together and seek ways to manage our patients’ discomfort by avoiding or at least limiting the use of these highly addictive narcotics. In addition, the availability of many of these medications is becoming increasingly challenging for a variety of reasons and ongoing shortages are predicted to worsen over the next 2-3 years.

As part of our commitment to assist our providers and the patients we all serve, we will soon pilot an Enhanced Surgical Recovery (ESR) program with our colorectal surgeons. This program will help patients and their providers choose a multimodal approach to pain management that significantly reduces the need for post-surgical narcotic medication. The program is based on evidence based medicine literature and protocols and has proven success in many hospitals in Europe and across the US. We are very excited and optimistic that our patients will benefit greatly from this program, including a significant reduction in opioid-related sided affects and a decrease in their average length of stay and complications. We plan to offer this to other surgical specialists once the pilot is complete. In addition, we are also planning to start work this year around a hospital-wide opioid reduction strategy and we will likely reach out to many of you to assist us in this effort.

Quality Update

In 2017, we saw a significant improvement in our DVT/PTE, MRSA, and C. difficile rates across the hospital. Much of this was due to the engagement and involvement of members of the medical staff serving on committees and helping to improve order sets, processes and policies. We continue to face challenges in our overall mortality rate, with an average index >1.0 (HCA benchmark is 0.7), along with hospital-acquired infections, especially CAUTI, CLABSI, and surgical site infections. We have dedicated additional staff resources in all of these areas for 2018 and we need your help in improving our care quality in these important areas. Here are some ways that you can help us provide safer care at the facility:

• Please consider opportunities to avoid foley catheters and central venous access lines when alternatives exist and work with nursing colleagues to remove lines and catheters as soon as feasible. Also, we are close to offering an IV Team in the hospital staffed by some of our infusion center nurses and so mid-lines and PICC lines will be more readily accessible in the near future! Stay tuned!!
• Please continue to follow our hand hygiene protocol such that you are using the readily-available dispensers both on your way into and also out of each patient room.
• Please continue to follow recommended guidelines around antibiotic utilization and de-escalation in the facility and if you have questions, our AMP (antimicrobial stewardship) team is always available for a conversation.

Clinical Documentation Improvement Brief

Recently, HCA adopted a new query process and software program that promises to give providers much more helpful and detailed information. As with all changes, there are some new challenges with query responses.

The query is not complete without a response in the text box or by checking the appropriate box provided in the Epic query form, if available. If the query is signed but not completed appropriately, it will be sent back to you for additional information. If the check box functionality is available, please check the box that is applicable to the diagnosis of your patient. Clicking more than one box will result in conflicting information and the query will be sent back to you for clarification.

CDI Tips

As part of our ongoing education around appropriate documentation, we would like to highlight the following areas. Again, appropriate and detailed documentation helps your patient and the hospital by accurately representing their episode of care which, in turn, allows us to more clearly demonstrate their level of severity.

Use of the term, “Insufficiency” - Respiratory or Renal - codes to a generic disorder of respiratory system or renal disease. It does not add any weight to the illness severity of your patient. Failure and insufficiency are not interchangeable in coding diagnoses. Please be as specific as possible when assigning diagnoses to your patients to support medical necessity and severity of illness.

Acute renal disease does not code to acute renal failure and that term could result in a query.

Sepsis - We continue to struggle with incomplete or insufficient documentation around patients with sepsis and we believe this is also falsely representing the work you do by not accurately displaying severity of illness. Please make sure you are documenting as completely as possible the type of sepsis, its acuity, its severity, POA (present on admission) or not, and associated factors.