THE MATCH GAME
They’re in every department — in the emergency room, in cardiology, pediatrics, the family care centers, and on all the floors. They used to be called “interns” but now they’re known as PGYs, which stands for postgraduate year. The training of some residents can be for only one year (PGY-1) while for others, the curricula may last as long as five, depending upon the specialty. They come to Ohio Health through programs that match applicants with the hospital and specialty.
“Matching has become increasingly challenging,” observes Dr. Pam Boyer, Director of Medical Education at Riverside. “Students are more interested in high tech specialties like radiology and anesthesiology than in primary care and internal medicine.” Unlike the family-oriented specialties which require long and unpredictable hours, “they want a more defined and clear-cut schedule. And they’re looking to balance work with family life.”
Ohio Health and particularly Grant, has been able to bridge the gap, however. Nationally, 21 percent of the family practice residency slots went unfilled in [2003? 2004?], while in the central region, of which Ohio is part, 28 percent remained empty. Across all 24 specialties, about one-third of the total vacant positions in were in family practice. Yet Grant was able to fill all 12 of its PGY-1 family practice positions.
Dr. Dave Hamilton, Executive Director of Medical Education at Grant, attributes the success to a vigorous recruiting program and a strong sense of community among the staff. “We produced a CD-ROM that was designed by residents, faculty, and staff,”” he says. “Along with photographs and biographic descriptions of everyone, we had segments about every aspect of the program, from doing rounds on the floors to softball games. Residents talked about what they learned at Grant.” All applicants expressing an interest in Grant’s program receive a copy of the CD.
He also points to an especially rigorous training agenda. “Our program is unique because we don’t have internal medicine residencies. So family medicine provides the primary care. Our residents learn more about the care of critically ill people than in other settings.” Although they must work must harder, “they feel the superior training has given them an edge in their careers.”
Like Riverside and Grant, Doctors Hospital relies on word of mouth to draw high-quality residents. “We travel to medical schools and meet the students one-on-one,” explains Melissa Kaufman, Administrative Director, Department of Medical Education at Doctors. Because Doctors is an osteopathic hospital, “the guidelines are somewhat different.” Implemented by the National Residency Matching Programs (NRMP), the Electronic Residency Application Service (ERAS) matches medical students nationwide and is used at Riverside and Grant. Applicants for residency at Doctors go through the National Matching Services (NMS).
Both MD and DO applicants can apply for residencies at all Ohio Health hospitals. And regardless of their specialty, they do double duty. Days often begin at 6AM and end after 9 at night, a non-stop blend of classes, teaching rounds, and supervised patient consultations. They may also be on call on certain nights, which means they stay at the hospital where there’s a lounge to catch a brief nap or take a quick shower.
Although recent Accreditation Council for Graduate Medical Education (AGME) rulings limited residents’ workweeks to 80 hours, “that’s still a lot,” adds Dr. Boyer. “Along with diagnosis and procedures, residents are learning professional development and ethics. We also teach them to recognize the impact of sleep deprivation and the signs of stress in themselves and in others.”
Communications skills — with patients, other residents, and staff – are also emphasized. “We’re looking for people who are well-rounded, humanistic and team players, along with being lifelong learners,” she continues. It also helps if they drink a lot of coffee.
ENHANCED SECURITY AT RIVERSIDE: MONITORING THE “HUMAN SHOW”
Hospitals are for healing and providing support. But they can also be happy hunting grounds for criminal activity. “People are at their most vulnerable,” observes Chuck Smith, Director of Security and Protective Services. “They aren’t as aware, leaving things like purses unattended and vehicles unlocked.”
But the good news is that a newly enhanced security system at Riverside and Grant not only connects OhioHealth with its more than 20 neighborhood health centers but provides an upgraded monitoring of Riverside itself. The latter includes over 200 cameras which digitally record the comings and goings of everyone, and continue to perform such minutia as zooming in on license plates. “This represents a huge improvement,” he adds. “Rather than spending hours plowing through reel after reel of videotape, we can punch in a time and immediately pinpoint an incident and see what’s going on.” This makes crime-solving easier and frees up investigators for other tasks.
Alarms at the various healthcare satellites go through a central system at Riverside. Problems can range from someone being locked out of their car to a stuck elevator to more serious matters, such as assault. “We have an interface with the fire and police departments,” continues Chuck. “So they can quickly handle matters within their purview.” And it’s non-stop: “We get something like 10,000 calls a month for service and over 160,000 calls relating to suspicious activity.” Fortunately most are of the routine variety: “When something happens, people don’t know who to call, so they contact us.”
A visit to Riverside’s new security control center allays any fears that Big Brother is watching you in particular — unless you’re doing something wrong, of course. (There’s also a control center at Grant.) Sixteen large-screen color TVs hang clustered above a dozen computers; some of the TVs have split-screen images of several departments. Usually two security specialists are on deck, either working at the keyboard or on the phone. They barely glance at the TVs, although occasionally an employee in the know will wave at the camera. “Before, the monitors were much smaller, in black-and-white,” he points out. “Color is cheaper and of much better quality.” The larger center also allows space for the hospital’s expansion. For instance, several cameras have been added because of the new emergency department and the McConnell Heart Center.
Enhanced security makes the hospital safer for visitors and employees. “By taking a proactive approach, we help deter and solve crime.”
NEW SYSTEM AT DOCTORS TRACKS MORE THAN NUMBERS
It seems amazing, but crunching numbers can actually help with the treatment of patients. TSI, a software package just instituted at Doctors, provides support for both financial and clinical decisions. “Along with answering such questions as, ‘How much does a tonsillectomy cost?’ we can identify the most effective treatment of conditions such as congestive heart failure,” observes Nathan VanLaningham, Vice-President of Finance at Doctors. TSI also assesses profitability issues, such as evaluating changes in third-party contracts, and their impact on net revenue.
But TSI’s effect on how medicine is practiced is its most intriguing aspect. “Medicine is both an art and a science,” he continues, and TSI assists with the latter. By bringing expenses from a general ledger system and patient data from the hospital information system, “”it marries the data so costs are correctly allocated to every single procedure.”
TSI also tracks diagnosis data on patients. For example, “if two patients have the same severity of illness and one goes home recovered while the other is readmitted after three days with no improvement, we need to understand the differences in practice patterns that caused the discrepancy in patient outcomes.”” This kind of information can be used by the medical staff to develop the most effective treatment plans for a particular condition and/or stage of illness. Such guidelines and other innovations of the medical staff, “will benefit both patients and stewardship of hospital resources.”
Cardiology is the first department to use TSI, with the goal of hospitalwide implementation over the next several months. Along with information on contracts, the system will gather data on charges, costs, and codes for patients, groups, physicians, drugs, and procedures as well as accounts payable and other financial statistics. “We’ll be able to estimate reimbursements and identify costs,” states Nathan.
Once the initial data and budgeted targets are plugged into the system, all information will be reviewed and validated by the clinicians and department managers. Then cost data for services provided will be developed by the OhioHealth decision support team, with results and reporting shared with the medical staff and throughout the organization. This will enable clinical department managers to not only better utilize their budgets but to also accurately allocate resources.
“TSI is a powerful tool that will help us not only track when we get paid, but what it costs us to provide the service. It may change the way we do business.” Not to mention giving the patients the benefits of evidence-based decision-making.
RIVERSIDE: BACKING UP NEUROSCIENCE
The Riverside Neuroscience Institute is growing! In addition to a new Spine Center, the current 12 bed Neuro Critical Care Unit is expanding to 18 beds, and an Epilepsy Monitoring Unit is being added to what has become “a very high-quality, fast growth area, ” states Donna Hanly RN, Director of Critical Care and Neuroscience. “”We have more Neuroscience physicians, care for more Neuroscience patients and do more Neuroscience procedures than any other hospital in Central Ohio.”
Although the ability to closely monitor and manage their patients’ progress is good news for the neurosurgeons, neurologists, orthopedic surgeons, highly trained nurses and other skilled personnel, patients really benefit. Now all spine and neurological patients will be treated in specialized locations. “They will receive immediate, specialized care and directly benefit from dedicated resources and specially trained staff,” Hanly continues.
Focus is on total care, “from the initial consultation, when the patient first comes to see us, through the recovery period, ” she adds. Treatments encompass the phases of critical, intermediate, and acute care as well as preventative, conservative, surgical, post-surgical, and rehabilitative services. “We use a comprehensive approach, from diagnosis and treatment, to health and prevention.” Patient education is another area of focus.
According to the American Academy of Orthopedic Surgeons, nearly 12 million physician and/or emergency room visits are made each year because of back problems. Of the $16-plus billion spent annually on the management of back pain, over half of that is on surgical care. Riverside has responded to the growing demand for treatment of patients with back pain.
Patients also benefit from cutting-edge technology such as clot retrieval for stroke patients. Riverside just garnered the JCAHO Disease-Specific Certification for Stroke — the first hospital with such designation in Ohio — and offers a full range of therapies such as immediate administration of the “clot buster” tPA which can greatly decrease the devastating effects of a stroke. The Neuro Critical Care Unit will also be utilized for patient with aneurysms, brain tumor surgeries, head traumas, and related disorders.
The Epilepsy Monitoring Unit, which will open in October, will add to Riverside’s neuroscience comprehensive care by providing diagnostic and therapeutic treatment options for patients with epilepsy. “Our goal is to be the best place in the country for patients who need spine, stroke, or care for any neurologic disorder,” concludes Hanly. “We’re continually striving to improve customer service and quality and consistency of care.””