HOSPITAL UPDATE: Marin General Hospital: Winter 2012

Susan Cumming, MD

Note: Each issue of Marin Medicine includes a self-reported update from one local hospital or clinic, on a rotating basis.

 

 A year and a half after the Marin Healthcare District regained control of Marin General Hospital, the facility is thriving. As a full-service, acute-care hospital, MGH provides a trauma center, comprehensive cardiac and neurological surgery programs, labor and delivery services, and a nationally recognized cancer care center.

Under our new leadership, MGH is pushing forward. With new industry awards and certifications, expansion of services, deployment of electronic health records, retention of nurses, staff and physicians, and significant community donations of nearly $9 million to date, this past year and a half have brought great change and activity.

Key to the hospital’s future are expanded capabilities, including elective neurosurgery at the new Spine & Brain Institute, the only program of its kind in Marin. The launch of the institute is just one example of a broader strategy to align with our physician community for the benefit of our patients.

Many of our services have been recognized at a national level. In 2010, we earned the Joint Commission’s Gold Seal of Approval for both our hospital and behavioral health services, and we were designated a Breast Imaging Center of Excellence by the American College of Radiology. We also received accreditation from the American College of Surgeons’ breast-center accreditation program, and our Marin Cancer Institute was awarded eight out of eight possible commendations by the ACS’s cancer commission.

We are also the first hospital in Marin County to receive full accreditation for percutaneous coronary intervention from the Society of Chest Pain Centers for our treatment of acute coronary syndrome. Finally, our stroke program has been certified by the Joint Commission and has received a quality achievement award from the American Heart and Stroke associations.

In September 2011, MGH took a big step towards eliminating paper charting and enhancing patient safety. We deployed a new application, Clinical Care Station, to enable electronic charting, electronic clinical records and medication bar coding. The Paragon charting application allows bedside entry of clinical information and seamlessly interfaces with other clinical applications already in use at the hospital. Because patient handover between nurses at shift change can now occur in the patient’s room, the new system will allow for increased patient involvement and better communication. The medication bar-coding application is integral to preventing medication errors. And no more chasing down the chart on morning rounds!

The implementation of Clinical Care Station is the first step toward demonstrating “meaningful use” of electronic records under federal regulations. The next step, computerized provider order entry, will be implemented during 2012. MGH is also working on protocols needed to create a health information exchange, a central database that can be shared by all providers involved in a patient’s care, regardless of the site of care. Such an exchange will offer a patient-centered approach to accessing clinical information.

Recent technology purchases at MGH include a PET/CT scanner and new breast imaging equipment, both made possible through funding by the MGH Foundation. The new, state-of-the-art scanner provides detailed 3-D images, especially useful for cancer and cardiovascular care, and has an open design that makes scanning more comfortable for patients. In September 2011, we opened a new electrophysiology lab, which will allow faster, safer ablations and device implantations. Plans are underway for a second 64-slice CT scanner and upgraded MRI equipment.

As an independent community hospital, collaboration with other organizations and with community partners is critical for MGH. The most significant recent example of our collaborative efforts is our work on reducing hospital readmissions. In September 2010, I attended the first meeting of the Avoiding Readmissions Collaborative, an initiative supported by the Gordon and Betty Moore Foundation. ARC’s goal is to help participating organizations reduce 30- and 90-day readmissions by 30% by 2013.

Early in 2011, with funding from ARC, we established a cross-continuum work group, the Care Transitions Collaborative (CTC), which included representatives of hospital departments and leadership, Marin County Health & Human Services, PRIMA Medical Foundation, Hospice by the Bay and Palliative Care, Sutter Care at Home, Marin Community Clinics, Marin-Sonoma IPA, and a patient representative. The CTC team identified four key areas for intervention: patient education, medication management, team communications (both within the hospital and post-discharge), and post–discharge support systems, especially for older adults.

The CTC team is still developing plans to address those four areas, but MGH has already adopted an innovative technology for team communications: Carebook, a multidisciplinary care collaboration tool. Care providers inside and outside the hospital can use Carebook to form multidisciplinary care teams, collaborate on safe transition plans for their patients, coordinate care across the teams, and engage patients and caregivers with a patient-centered after-care map. MGH will deploy and administer Carebook and also make it available to community partners.

Our work with readmissions has evolved into a new initiative, the Collaborative for Older Adults Safe Transmissions Program. In late October 2011, we received a $750,000 grant from the Gordon and Betty Moore Foundation to implement the program, recognizing the need and our innovative community based approach. The work is just beginning, but we are optimistic the program will offer a new paradigm for improving not only the health of our patients, but also their experience of care.

We are grateful for the generous contributions received from the Marin County community since the hospital’s transition to public control—nearly $9 million to date. Our fundraisers during 2011 have included the “Night in Marin Gardens” gala, which raised more than $400,000, and the “Taste of Tokyo” golf tournament at the Meadow Club, which raised more than $300,000. Both will become annual events.

With these and other contributions, we have been able to launch the Spine & Brain Institute, purchase the PET/CT scanner, begin major expansions and upgrades to our emergency department, and update our breast imaging equipment. We also plan to launch an outpatient diabetes program.

It has indeed been a busy year for all of us at MGH, and the pace is unlikely to slow down in the near future. Change creates challenges, but it also creates opportunity. I believe this past year and a half have demonstrated that MGH remains strong. We are continuing to focus on our patients as we work to raise the bar on healthcare in Marin.

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Dr. Cumming, a senior fellow in hospital medicine, is medical director of Marin General Hospital.

Email: cumminss@maringeneral.org