My Goodness, MyChart! Numerous New Features Coming in 2017

In 2017, SCL Health is greatly expanding our MyChart capabilities by adding nearly 20 new functions starting in the second quarter of the year. Most of the planned changes for our MyChart will provide a better experience for patients and, at the same time, a more efficient experience for providers and associates. Additionally, many of the enhancements will help us meet national healthcare requirements and keep our organization competitive in our markets.

Today’s patients are looking to engage online with their healthcare providers, seeking greater convenience and access. In fact, a recent study published in Healthcare Informatics indicated that as many as 87 percent of people want access to a robust patient portal. And surprisingly, patients in their 60s access patient portals at rates similar to those in their 30s, 40s and 50s – and they use it more often.

Our MyChart accounts already include the ability for patients to schedule or request appointments with their providers, access parts of their medical records, view lab and test results, and send messages to providers. Now we’re adding new functions that will roll out in phases throughout 2017, beginning in the second quarter. Here’s an overview of some of the key features that will be added to SCL Health’s MyChart in 2017:

  • Online bill pay within MyChart – Patients will see account summaries, payments, and pay bills directly through MyChart, as well as contact customer service.
  • Wait list notifications – Allows patients to request being added to a provider’s wait list to be offered earlier appointment options as they become available.
  • Text notifications – Allows mobile users to receive text messages when they have new notifications in MyChart.
  • Patient records release – Makes it easy for patients to request release of patient records directly to their MyChart accounts.
  • Apple Watch™ integration – Allows patients to wear their medical information on their wrists by pairing their iPhones with the Apple Watch™.
  • Referrals – Patients with active MyChart accounts can view their health information and request a referral from their PCP to a specialist.

MyChart is one of SCL Health’s strategic priorities related to Person-centered Care and Growth. Providers, associates and patients will be hearing a lot more about the exciting new MyChart capabilities throughout 2017. Watch for more information about training and updates on the new functionality.

Ask your provider for MyChart access if you haven’t already, and encourage our patients to sign up and use MyChart as a valuable and convenient part of their healthcare management and experience. Visit mychart.sclhealth.org.

Help Our Patients Get Some ZZZZZs

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Like any big city with a night life, hospitals are bustling with activity 24 hours a day, seven days a week. Unlike those visiting a big city, that’s exactly the sort of thing our guests don’t want.

Patients deserve a healing environment that is as peaceful as possible, despite the inevitable noises on a hospital floor. Hospitals that take actions to keep the care environment quiet report significantly higher patient experience scores than those that don’t.

That’s why SCL Health is working to educate our associates on how to create quieter and more restful environments day and night at our care sites, in order to provide the most healing environment possible and help our patients to have better experiences and better outcomes. Nursing and quality leaders say even just a few simple things can make a big difference in how patients feel – and rate us – during their stay.

For instance, some patients have reported being unable to rest due to the personal conversations overheard in hallways, while others talk about the incessant sounds of alarms throughout the night.

So, what can you do to promote a calmer clinical environment?

  • Be intentional about identifying and reducing unnecessary noise such as conversations, preventable call lights and alarms.
  • Put in work orders for squeaky doors and wheels, or other noisy equipment.
  • Communicate with our patients that we are committed to creating a restful environment. Offer them a quiet kit (ear plugs and eye masks) if you know there will be construction, for example. Let them know how long it will last, and perhaps offer to shut the door, if appropriate.
  • Engage with the rest of your team around a quiet environment. Be accepting of feedback from your colleagues, and be willing to give feedback and take action on your own when you see opportunities to reduce noise for our patients.

 

SCL Health Achieves Record Low Falls, but More Work to be Done

SCL Health saw its lowest rate of falls in almost four years in September, thanks in large part to work from care sites across the system to share best practices with one another. The organization saw just 59 falls and 1.88 falls per 1,000 patient days across eight care sites in three states.

There’s still more work to be done. Even one fall is too many, quality leaders say, and not all targets are being met.

Even so, September reflects the progress as the organization leverages skill, scale and learning to achieve ministry excellence.

Leslie Kunz, RN, Director of Medical/Surgical Services at Good Samaritan Medical Center, attributes the success to the work of the multidisciplinary Falls Collaborative team composed of associates across all care sites. The group, originally formed in 2013 with a Leven Grant aimed at decreasing falls and falls with injury, examines, evaluates, trials and implements best practice strategies to achieve a sustainable reduction in preventable falls and resulting injuries. Leven Grants are grants that SCL Health’s Leven Foundation confers for safety projects.

Particularly valuable, Kunz said, is the sharing of best practices across the system and giving care sites ownership in correcting the challenges and holding them accountable for improvement.

“The focus has been on consistent best practices, which include a post-fall huddle; consistent messaging to our patients about ‘call, don’t fall’; and being with our fall-risk patients (in the bathroom),” she said. There is a high correlation between bathroom use and falls.

The group then shares best practices and challenges on a monthly basis. “Our units that are having the most challenges, we have them work on ways to decrease those falls and then present those to the Collaborative,” she said.

Note: Green arrow is the target, while the green line represents the mean fall rate. Process shifts are represented by shifts (up or down) of the mean and control limits (red dotted lines).

Note: Green arrow is the target, while the green line represents the mean fall rate. Process shifts are represented by shifts (up or down) of the mean and control limits (red dotted lines).

In November 2014, the Falls Collaborative set goals of a 20% reduction in both fall rate and falls with injury rate by the end of 2015. The system will not achieve either target by year’s end, said Chris Bliersbach, Senior Director of Clinical Outcomes for SCL Health. But metrics show steady movement in that direction.

Holy Rosary Healthcare, for example, met its 2015 targets for reducing falls and falls with injury, with a 24% reduction in fall rate and a 46% reduction in falls with injury rate. Saint Joseph Hospital met its falls with injury reduction target, reducing it 16 percent, and Saint Joseph Hospital’s fall rate continues to be the system’s lowest. Lutheran Medical Center’s fall rate is the second lowest in the system, and its 0.34 rate of falls with injury is the system’s best.

The Falls Collaborative in 2013 initially set a goal for 2014 of 33 percent reduction in falls that are classified as Hospital-Associated Conditions (HAC), and a 10 percent reduction in falls with injury. The team achieved an HAC fall reduction of 19 percent, but the fall rate per 1,000 patient days was reduced by 13 percent and the falls with injury rate was 30 percent – triple the 10 percent goal.

Bliersbach points to these milestones as also deserving of mention:

• Both Lutheran Medical Center and Saint Joseph Hospital fall rates are well below the National Database for Nursing Quality Indicators (NDNQI) 25th percentile;
• St. James Healthcare has reduced its fall rate by 15 percent year-to-date;
• St. Mary’s Medical Center reduced its fall with injury rate 13 percent;
• Good Samaritan Medical Center’s fall with injury rate has been below the historical average in six of the past seven months;
• St. Francis Health achieved its second lowest fall rate over the past year in October, and a low fall with injury rate;
• Since June 2015, when SCL Health instituted a targeted reduction effort on the Top 10 high volume units, there has been a 38 percent reduction in the average number of falls per month, from 42 to 26.

Platte Valley Medical Center was not included in the analysis, but will be offered the opportunity to join the Falls Collaborative in 2016.

Efforts to reduce falls with injury consist of a number of measures, Kunz said. Among them, care sites are looking at updating patients beds to have more of an indication whether a bed alarm is on or off and if the side rail is up or down; implementation of the hourly rounding bedside report initiative; and an assessment of patients prior to admission to determine fall risk.

“All of these interventions plus several others are going to be what it takes us to get to the next level of reducing falls with injury,” Kunz said. “Data shows that if the elderly have a fall with injury, their mortality is increased. Our mission is to do no harm – keep our patients safe.”

Getting our Patients out of Limbo: Observation Care

For years hospitals have been challenged by patients who are not quite well enough to go home yet not quite sick enough to be admitted, at least right away. This limbo period, known as observation status, can be a confusing time for patients and even staff. Not anymore. SCL Health is revamping the way it handles observation care in a major initiative that’s designed to improve the patient experience and deliver more efficient care.

When a patient arrives in the ED (bleeding or out of breath or in great pain – or worse), the physician and care team must quickly see what’s going on and decide if the patient needs further care. That’s not always black or white. Sometimes it takes more time, testing and, yes, observation, to understand what’s going on.

What’s new about observation care?

These three physicians at Saint Joseph Hospital are among the many physicians systemwide who will be caring for Observation patients throughout SCL Health. Pictured are Hunaif Dar, MD; Shai Feingold, DO; and Amy Staggs, MD.

These three physicians at Saint Joseph Hospital are among the many physicians systemwide who will be caring for observation patients throughout SCL Health. Pictured are Hunaif Dar, MD; Shai Feingold, DO; and Amy Staggs, MD.

All SCL Health care sites are banding together to design and roll out a new model for observation care – from determining the patient status, coordinating care among providers and staff, streamlining documentation and order sets, and most importantly – communicating with patients.

“We asked ourselves, ‘Could this be done in a way that serves the patient better?’” said Christy Chaudhuri, MD, the co-physician lead for the project at SCL Health. “The answer was ‘Yes,’ and we are incredibly excited about our innovative new design for this specialty area of observation, and how it will improve the patient’s experience and streamline the care we provide.”

For the past nine months, teams of caregivers and leaders at every SCL Health care site have been involved in creating a comprehensive and innovative design for a new model of observation care. The design step is complete, and the organization is now beginning the full-steam-ahead process of implementing the new model by December 2015.

Watch this seven-minute video with an overview of SCL Health’s vision for the Observation Redesign project:

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What Observation Redesign means to associates
Detailed training and communication is starting to take place for the associates and caregivers who touch any aspect of observation care, including patient access, registration, nurses, physicians and patient billing. Teams are creating awareness, training and communication around these enhancements:

  • New observation care teams (OBS Navigator, OBS MD and OBS RN).
  • Orange wristbands and orange header banner in Epic for observation patients.
  • Dedicated spaces for observation patients at some of our care sites.
  • Reduced cycle times for ancillary testing for observation patients.
  • New observation Order Sets.
  • Streamlined documentation for caregivers.
  • Improved communication tools and visual aids to more quickly designate patient status and begin a care plan.
  • Patient education materials (letter, flyer, conversations).

A case study: Fred arrives in the ED, short of breath
To understand what the new model of care will look like, let’s consider the experience of a typical patient.

“Fred” arrives at the ED, acutely short of breath, with his worried wife at his side. He’s quickly registered, and the medical team begins to evaluate him. He receives an X-Ray, and the results look good. He receives a CT scan, which reveals the problem: a pulmonary embolism (one or more arteries in the lungs are blocked by a blood clot). Fred is given pain medicine, oxygen and a blood thinner, and immediately begins to breathe better.

The ED doctor discusses Fred’s care with the Hospitalist (the designated Observation MD), who makes the decision that Fred will be an Outpatient with Observation Services. He’s stable but he needs to continue to be monitored, and he’s probably not sick enough to be admitted. Observation care will keep him safe while the staff creates a care plan and monitors his condition, so he can go home as quickly as possible. Fred gets an orange wristband so the entire care team knows he is under this specialty area of expedited care.

The Observation Navigator sits down with Fred and his wife, gives them printed information and tells them what observation care means, how long Fred will likely be in the hospital, how observation costs and inpatient costs are different, and that he may have a higher co-pay and deductible. However, the Navigator helps find the best options for Fred to receive follow-up tests and care from his physician once he leaves the hospital.

By the next morning, Fred is completely stabilized and safely sent home, with a 5-day supply of self-injections and pills, and an order for follow-up care from his own physician. Fred and his wife are happy that he can be home and get the remaining care from his physician, rather than having to be in the hospital. The outpatient costs are higher than the same tests as an inpatient, but overall, Fred’s costs were less since he was in the hospital for a shorter amount of time, and his physician can provide his care moving forward.

Christy Chaudhuri, MD, FHM, CEO/Medical Director and Hospitalist of Midtown Inpatient Medicine, and co-physician lead for SCL Health’s Observation Redesign project.

Christy Chaudhuri, MD, FHM, CEO/Medical Director and Hospitalist of Midtown Inpatient Medicine, and co-physician lead for SCL Health’s Observation Redesign project.

“In the past, patients were assigned to observation status without really knowing what that meant, what it would cost, whether they needed to be admitted to the hospital in the first place or if they could get the necessary care from their own physician,” said Dr. Chaudhuri. “Now they will understand what observation means and their stay will feel more like expedited care in an outpatient setting.”

It’s a new era of healthcare, and all health systems are trying to understand how to provide excellent care more efficiently. SCL Health is embracing this new care model designed to meet the needs of patients and caregivers by streamlining the process for all involved.


 

Questions about the Observation Redesign process? Please contact one of the following care site team leaders:

  • St. Vincent Healthcare – BJ Gilmore, CNO, or Katie Roedocker
  • St. James Healthcare – Shannon Holland, CNO, or Helen Cummings
  • Holy Rosary Healthcare – Carol Enderle, VP Patient Care, or Alisha Anderson
  • St. Francis Health – Mary Clare Wilson, Director Quality
  • Lutheran Medical Center – Christina Johnson, CMO, or John Valentino
  • St. Mary’s Medical Center – Shelley Peterson, CNO, or Ann Jeffries
  • Saint Joseph Hospital – Barb Jahn, COO, or Deborah Campbell
  • Good Samaritan Medical Center – Susan Kerschen, CNO, or Barbara Carnes/George Payan

3 Care Sites Earn Top Marks on Hospital Report Cards

LeapfrogScoresThe Leapfrog Group has released its fall 2015 report card, which assigns letter grades to hospitals twice a year, based on performance on 28 safety measures related to error prevention, injuries and infections.

See how your hospital fared:

  • A – Good Samaritan Medical Center (Lafayette, Colo.)
  • A – Lutheran Medical Center (Wheat Ridge, Colo.)
  • B – Platte Valley Medical Center (Brighton, Colo.)
  • B – Saint Joseph Hospital (Denver, Colo.)
  • A – St. Mary’s Medical Center (Grand Junction, Colo.)
  • B – St. Vincent Healthcare (Billings, Mont.)
  • C – St. James Healthcare (Butte, Mont.)
  • C – St. Francis Health (Topeka, Kan.)
    (Note: Holy Rosary Healthcare in Miles City, Mont., was not rated by Leapfrog since it is considered a critical access hospital, not a general hospital.)

While Leapfrog is just one of many third-party organizations that rate hospital quality using different data and methods, SCL Health has made several promising improvements over last year’s marks.

Since fall 2014, three of our care sites increased their scores. Good Samaritan rose from a C to an A; Saint Joseph rose from a C to a B; and St. Mary’s increased from a B to an A. All other care sites maintained the same grade, except for St. Vincent which saw a decrease from an A to a B.

“These positive results were achieved through collaboration among our care sites,” says Jennie Dulac, VP, Chief Quality Officer. “Key stakeholders reviewed and answered each question collectively, and we shared accountability for data support and analysis. As a system, we are responding to the communities we serve and continuing to improve upon how we deliver efficient, effective and reliable outcomes of care.”

Scores are updated twice a year in April and October. To assign a letter grade to each hospital, Leapfrog uses data from the voluntary Leapfrog Hospital Survey and also pulls data from the Centers for Disease Control, CMS, the Agency for Healthcare Research and Quality, and the American Hospital Association. The October scores include updates from the Hospital Compare data.

Why Care About Why Round? Here’s Why

It might seem too simple or too easy for the complex world of healthcare in which we work. But taking the time to check in with patients and each other, a practice known as rounding, is proven to drive better outcomes in patient satisfaction and even quality.

When nurses round on patients, patients feel valued and listened to. In many cases, this brief “check in” may identify a potential care or comfort issue that gets addressed earlier than it would have otherwise. When leaders round, it demonstrates that extra level of person-centered care to both our associates and patients. Consider when a restaurant manager stops by your table just to check in. For most of us, that simple act tells us we are valued as customers.

To instill the importance of rounding at our hospitals and clinics, SCL Health’s Quality Department is launching a “Y Round?” campaign to prompt discussion and awareness of this practice and its role in achieving our quality, safety and patient satisfaction goals. The campaign focuses on three key messages for patients:

  • To keep you safe
  • To anticipate your needs before you have to press the call button and wait
  • To engage you and your family as partners in your care

Associates may see colorful posters in the halls and hear leaders talking about this initiative. Help us educate others about the importance of this practice in help us on our continuing journey to deliver the very best care and experience.

Yround

 

Program Bridges Gap Between Mental, Physical Health

Katie Paganucci (left), Sandy Cavanuagh (center), and Pat Kyle stand with the Mother Xavier Ross Award.

Katie Paganucci (left), Sandy Cavanuagh (center), and Pat Kyle stand with the Mother Xavier Ross Award.

The correlation between physical health and mental health is widely recognized, but practical solutions to addressing the two have eluded many health care professionals.

Good Samaritan Medical Center, in partnership with SCL Physicians and others, is trying to tackle this problem with a program that earlier this year won SCL Health’s Mother Xavier Ross award.

Good Samaritan earned the Mother Xavier Ross award to continue a program that integrates mental health professionals into SCL Physician offices.

“We were very pleased to find that we did win that award and we now have an additional $50,000 that we’re putting into the program over the next 12 months,” says Sandy Cavanaugh, Vice President of Mission and Community Relations.

In 2012, Good Samaritan conducted a community health needs assessment and found that residents of Boulder and Broomfield counties, where many of Good Samaritan’s patients live, reported mental health satisfaction lower than most other counties in Colorado. This result came despite availability of mental health services that is greater than many counties in Colorado.

Cavanaugh knew that patients coming into the Emergency Department were already in crisis and her search to treat people with mental health issues before this crisis point led her to a conversation with Dr. Steve Cobb, President and Chief Medical Officer of SCL Physicians. Before Cavanaugh could show him the health data from the community assessment he identified his greatest need as a physician.

“He said, ‘Primary care physicians need help with the behavioral health and mental health issues,’” recalls Cavanaugh. “‘But we need therapists to be located in our clinics so patients can get help before coming to the emergency room when they have a crisis in the middle of the night.’”

Cavanaugh worked with Mental Health Partners, a comprehensive community health center operating in Boulder and Broomfield counties, to place a counselor and a nurse practitioner in an SCL Physician clinic. Thornton Medical Center agreed to be the pilot clinic and the mental health professionals worked there one day a week.

“Immediately, as soon as we started the pilot, every slot that was available for an appointment was full,” says Cavanaugh. “It was only a few months before they said, ‘Can you double it and give us time two days a week?’ We did that, and then within a few months they said, ‘Can you double that, and we would like someone four days a week?’”

The program then expanded to SCL Physicians-Larkridge, and a number of other clinics around the Denver region have expressed interest. The money from the Mother Xavier Ross award will help expand the program, but Cavanaugh is learning more about how the program works with insurance companies, Medicare, and Medicaid, so that it can be sustainable and not reliant on grant money.

Even with limited hours from the counselor and nurse practitioner, the program helped 960 patients in its pilot year.

Dr. Julie Mullin has referred several patients to the mental health professionals working in her office.

Dr. Julie Mullin has referred several patients to the mental health professionals working in her office.

“I think most of us as family doctors feel that need for mental health because we see it every single day,” says Dr. Julie Mullin, who practices at SCL Physicians-Larkridge. “But I didn’t realize how much the patients would love it.”

Dr. Mullin had one patient who was experiencing anxiety and panic attacks, but didn’t realize what was happening. Dr. Mullin worked with the nurse practitioner to prescribe medication and connected her with the counselor.

“I just saw her a couple of weeks ago and she was really thankful for where she is at right now. She is in a place where she feels good and can control things if they are starting to happen,” says Dr. Mullin. “She is not somebody who would have normally sought out counseling.”

Cavanaugh and Dr. Mullin say that patients have benefited greatly from the program, but so have physicians.

“One of the physicians told me one time, ‘I’m a primary care doctor. When I’m off on the weekends and I get emergent calls from my patients who are ready to kill themselves, I don’t know how to handle that,’” says Cavanaugh. “The physicians are very, very pleased with it because they said they’re able to take care of the whole person in a much better way and they have help doing it.”

CNO to Nurses: I Support You

This message is for every nurse of SCL Health, from Geri Towndrow, system Chief Nursing Officer

As we celebrate Nurses’ Week, please know that you are incredibly valued, appreciated and needed every day. You are inspiring, and your passion shows.

The field of nursing has evolved, and we have all worked hard to embrace the changes, to learn new ways of providing care, and to integrate the art and science of nursing. We are increasingly challenged to do things differently. We are called to improve the experience of our patients and the health of our communities, while being extra mindful of our resources.

Yet our collective mission remains the same: to provide exemplary nursing care for every patient, every family, every time. If we make decisions in the best interest of the patient, we will always make the right decisions. As your system Chief Nursing Officer, I will support you as you make these difficult decisions every day in the best interest of the care and comfort of those we serve.

SCL Health nurses are known for great and compassionate work. Together, we have an opportunity to join our voices and our expertise, and to create the possibilities that push the boundaries of exceptional care.

Thank you for your healing work. Thank you for being a nurse.


Read the announcement about Geri Towndrow’s appointment as system CNO.

When Near Misses Can Kill, Reporting is Key

Imagine going to the pharmacy to pick up a prescription that, unknown to you, could have a dangerous interaction with another drug you take.

The pharmacist, thankfully, identifies the problem and you avoid a serious or even fatal reaction. The pharmacist then enters this “near-miss” into a reporting tool to ensure such a close call doesn’t happen again with other patients.

This is a culture of safety, and it’s precisely these kinds of actions that SCL Health is taking each day on its journey to become a High Reliability Organization, a term given to organizations such as airlines and nuclear power plants where the only acceptable outcome is no mistakes.

Every Issue, Every Time

“Every incident and near-miss should be entered into our event reporting tool. That’s how we learn from them,” says Amy Anyangu, RN, Director of Safety and HRO Development. “In order to prevent similar errors in the future, we must learn from every mistake we make today.”

To further improve associate use and adoption of this tool, our safety experts sought a name that would be more widely recognized and easily remembered. They turned to our associates for help.

Say Hello to PEARL

?????After a naming contest during Patient Safety Week, RL6 has a new name — PEARL (Practicing Event Accountability in RL). The safety team received 892 outstanding submissions from associates across our system.

The winning name was submitted by Anne Rivelli, RN, BSN, Ortho/Pediatric Unit, St. James Healthcare.

Beyond the acronym, the concept of a pearl speaks to the importance of the information we receive through this application. Like a pearl, everything we learn through the online event reporting system has value.

Remember to enter every incident and near-miss into PEARL as we continue on our journey to become a High Reliability Organization. Each entry contains a pearl of wisdom to share.

After Six Concussions, Student Educates Others About Head Injuries

Lacing up her soccer cleats and hitting the field has been a way of life for 18-year-old Alexis Torbert, but her passion for contact sports has come at a price.

“I’ve had six concussions that have been medically treated; my first one was in sixth grade,” explained Senior High School Senior, Alexa Torbert. “If I get another one, I will be out of contact sports forever.”

Concussions among student athletes is an issue that Athletic Medicine and Performance (AMP) physician, Dr. Ben Phipps, is passionate about. Trained in concussion management, Dr. Phipps has seen the impact a concussion can have on a student athlete.

“Concussions are currently a hot topic in sports medicine and for good reason.  We now understand that this is an injury that has the potential to have long-term effects, not just in sports but in everyday life,” said Dr. Phipps. “The key to helping a concussion is early recognition and treatment. Anything that raises awareness and improves concussion protections will help improve outcomes.”

Torbert admits that she will always have the “put me in coach” mentality, but she understands that concussions are a serious issue and need to be better understood. Because of this, the honors student decided to dedicate her senior project to the topic of concussions.

“I recorded interviews with several coaches, teachers and students about concussions and edited together a video, so it can be shown to student athletes at the beginning of each season,” Torbert explained. “The video is a unique approach to helping my fellow athletes and teammates understand what concussions are, how to recognize the signs and symptoms of a concussion and why it’s important to address concerns.”

AMP athletic trainer and Billings Senior High athletic trainer, Stacy Molt, has worked with Torbert throughout her high school career and commends the 18-year-old for her desire to benefit the community she was raised in.

“Alexa is one of those athletes that want to make a difference,” said AMP Athletic Trainer, Stacy Molt. “She took her experience of having a few concussions and turned it into a learning experience that will benefit the whole school and potentially the whole community. She is a go getter, very spunky and going to make a difference.”

Torbert’s concussions haven’t scared her away from the sport she loves, but she admits she has changed her approach.

“I’m still aggressive,” she insists. “But I don’t take unnecessary risks anymore.”

You can see her 3:46 min. video on YouTube here.

See her story in the Billings Gazette here.