Above All Else COMMITMENT TO EXCELLENCE
Mission
Table of Contents
Above all else, we are committed to the care and improvement of
Quality Care................................................................................2
human life.
Patients First...............................................................................6
Cancer Care
Vision
Nursing Excellence
Together, we will be the premier healthcare destination for all we serve.
Rapid Response and Efficiency...............................................12
Heart Care
Values
Stroke Care
• Integrity
Pain Care
• Compassion
Perseverance and Innovation.................................................16
• Always
• Respect
Teamwork and Determination................................................20
• Excellence
Trauma Care
Emergency Medicine
Neonatal and Obstetrical Care
Reproductive Medicine
Transplant Care
Health and Wellness ...............................................................26
On the cover: Joe A. Cates, MD, board-certified vascular surgeon, meets with a family member to share positive outcomes and describe the procedure that removed pancreatic cancer.
Wellness at Work
Health Insurance
Accreditations and Honors.....................................................30 Facility Maps............................................................................32
Dear Colleague, Now is a time of swift and dramatic change in healthcare. The Affordable Care Act and the push for more transparency for healthcare consumers, combined with the total transition to digital space for secure medical record storage and sharing, have led us to become the masters of change. Yet we remain steadfast to our mission to guide our priorities: “Above all else, we are committed to the care and improvement of human life.”
We deliver compassionate, high quality healthcare by focusing on the medical, spiritual and mental needs of each patient and family. Achieving the best possible patient outcomes while efficiently preserving healthcare dollars takes skill, in-depth planning and detailed follow-through. Working together, our physicians and staff are continuously advancing every one of our business pillars – clinical quality, patient experience, employee engagement, growth and finance – to provide healthcare excellence and high performance for our entire community. We created this report to illuminate our recent achievements and share our commitment to healthcare quality at Research Medical Center. Through a combination of patient stories, important information and data illustrations, we invite you to join our journey as we set our sights on becoming the best healthcare provider and healthcare employer in the region. By working together with you, the leaders and healthcare decision-makers of this community, we can further control costs, broaden access, enhance quality and encourage healthy lifestyles. Best regards,
Jackie DeSouza-Van Blaricum President and CEO Research Medical Center
1
Above All Else
QUALITY CARE
At Research Medical Center, we take quality performance very seriously. Working collaboratively with executive and clinical leaders to progressively improve patient care, our achievements are transforming Research Medical Center into a topranking U.S. hospital. To shed light on the levels of care available within our halls, this Above All Else Quality Report details our performance across several centers of excellence. We are proud to share this journey with our community as we continue to pursue ever-higher levels of quality and service. James A. Maliszewski, MD, board-certified internal medicine physician, and ShontĂŠ M. Hutson, RN discuss medication management at the bedside.
David S. McKinsey, MD, Performance Improvement Committee Chair Dr. David McKinsey (right) discusses quality improvements with Dr. Joel McKinsey (left) and Tien Nguyen, RN, 4West Charge Nurse (center).
3
QUALITY CARE
Excellence in Quality Care
who advocate for improvement in hospital care. As corporate advisors,
Hospital quality is measured in many different ways. Everyone, from
their work has been instrumental in determining what constitutes quality in
healthcare consumers to community and business leaders who make
healthcare and establishing a common set of safety, quality, and resource
decisions that drive healthcare choices, deserves to know the quality of
use standards to help purchasers make informed decisions about where to
care available at any given hospital. Research Medical Center is deeply
spend healthcare dollars. By design, only a few hospitals in a given region
committed to evidence-based healthcare that protects patient safety and
perform well enough to exceed these standards, and we are very proud to
leads to high quality outcomes. Our recent awards and performance data
be among them.
illustrate our journey of continuous quality improvement in overall hospital metrics (Figures 1 and 2) and across service lines. We are making high
As a 2014 Top Hospital, Research Medical Center demonstrates exceptional
quality healthcare more accessible in Kansas City than ever before, and it
standards of care that lead to lower infection rates, higher survival rates for
shows.
high-risk procedures, decreased length of stay and fewer readmissions.
A national Top Hospital. Research Medical Center is the only hospital in
“A” grade in hospital safety. Through its well-known
Kansas City to earn the prestigious 2014 Top Hospital award from The
Hospital Safety Score rating system, The Leapfrog Group
Leapfrog Group. We are among an elite group of only 60 hospitals our size
also awarded an “A” grade to Research Medical Center in
to earn this highly competitive distinction nationwide. The Leapfrog Group
2014. To calculate our hospital’s patient safety grade, The Leapfrog Group
is a nonprofit coalition of employers and other large healthcare purchasers
used multiple data sources that combine to illustrate how well we protect
Improving Overall Hospital Outcomes
Improving Care for Life-Threatening Conditions
1.6 1.4 1.2 1.0 0.8
Better 1.09
1.15
1.15 0.75
1.07 0.64
0.6
0.64
0.78
0.4 0.2 0
2011
Research Medical Center Mortality Rates
2012
2013
1.6 1.4 1.2
Expected
1.51
Better
Research Medical Center Expected
0.97
1.0 0.8
0.82
0.82
2013
2014*
0.6 0.4 0.2 0
2014*
Research Medical Center Complication Rates
Figure 1 Source: Research Medical Center, 2014. *Through September 2014
4
Overall Hospital Sepsis Mortality Rate, Observed and Expected
In Hospital Complications
In Hospital Complications
Mortality and Complication Rates, Observed and Expected
2011
2012
Figure 2 Source: Research Medical Center, 2014. *Through September 2014
our inpatients from accidents, infections, injuries, and errors. Our “A” grade represents extremely high performance in a rating system that is quickly becoming the standard measure of patient safety in the U.S.
Top Performer on Key Quality Measures. Also in 2014, The Joint Commission recognized Research Medical Center as a national Top Performer on Key Quality Measures® for 2013 performance, marking our second consecutive year receiving this distinction. The Top Performer award demonstrates excellence in heart attack, heart failure, pneumonia Frederic L. Seligson, MD is board certified in cardiac and thoracic surgery and specializes in cardiothoracic procedures.
and surgical care (Figure 3). We are among only 1,224 hospitals across the country to receive this most recent recognition from The Joint Commission (the nation’s leading accreditor of healthcare organizations), although nearly three times as many hospitals were eligible.
Top Performer on Key Quality Measures 100%
99.5% 100%
100% 100%
98.4% 100%
99.2% 99.3% Better
% of Patients
80%
Jeffrey W. Cameron, MD is board certified in general and vascular surgery and specializes in complex vascular surgeries.
60% 40% Research Medical Center 2013
20%
Research Medical Center 2014
0% Heart Attack
Heart Failure
Figure 3 Source: Research Medical Center, 2013-2014. *Through September 2014
Pneumonia
Surgical Care
William M. Beary, MD specializes in endobronchial ultrasounds and electromagnetic navigation bronchoscopies (superDimension™).
5
Above All Else
PATIENTS FIRST Cancer Care | Nursing Excellence
Megan Jones, 38, is fighting breast cancer under the care of Stephanie Graff, MD. Familiar with Dr. Graff through family and friends who have won their own battles against cancer, Megan requested a referral after diagnosis to begin chemotherapy at Research Medical Center. “From day one, Dr. Graff made me feel like a friend – someone she really wants to help, not just a cancer case,” says Megan. Her treatment is part of a clinical trial for people who carry an inherited BRCA1 gene mutation that elevates the risk for developing certain cancer types. Molly Lund, MS, CGC, board-certified genetic counselor, offers personalized and highly targeted care and prevention options to patients.
Megan Jones and Stephanie Graff, MD Megan Jones (left) discusses her breast cancer with her oncologist, Stephanie Graff, MD. With board certification in internal medicine, medical oncology and hematology, Dr. Graff specializes in breast cancer and actively leads a number of clinical trials to ensure patients have access to the latest developments in cancer treatments.
7
PATIENTS FIRST
Excellence in Cancer Care
Quality outcomes. To accelerate improvements in survivorship, we
For those in the fight against cancer, above all else, we believe in bringing
carefully manage changes in cancer care, treatment and surveillance
the latest treatments and technologies to Kansas City. From prevention
programs, and we continually measure our effectiveness against a range
and early detection to advanced cancer therapies and comprehensive
of national quality standards. Some standards are nationally accepted
oncology care services, Research Medical Center delivers excellence right
treatment guidelines proven to yield more favorable patient outcomes.
here, close to home and work for thousands of people in this community.
Others comprise indicators of quality, such as volumes, mortality and complications. For example, we meet the National Quality Forum (NQF)
Network of excellence. In 2014, we were honored to become a cancer
measures for post-breast cancer recommended therapies (Figure 5).
treatment center of the Sarah Cannon Cancer Network of Excellence
Our mortality rate for two high-risk surgeries – lung resections and
(Figure 4). Sarah Cannon, in partnership with Hospital Corporation of
pancreatectomies – are lower than the national average (Figure 6)
America (HCA), brings innovative minds together across 50 treatment
across all hospitals accredited by the American College of Surgeons’
centers to transform care and personalize treatment for cancer patients
Commission on Cancer (CoC).
here and across the world. Through our Sarah Cannon partnership, we are on the forefront of establishing molecular profiling for cancer patients which will allow us to personalize cancer treatment to the genetic profile of each patient’s particular cancer.
Upholding Best Practices in Breast Cancer Care Exceeds National Guidelines
100%
100%
100%
98%
% of Patients
96% 94% 92%
8
Figure 4 Source: Research Medical Center, 2014.
97.4% 94.4%
93.0% 91.5%
91.1%
90% 88%
Research Medical Center
86%
Missouri
84%
All CoC Programs
82%
Better
100%
Guidelines for Radiation Therapy
Guidelines for Chemotherapy
88.1%
Guidelines for Hormone Therapy
Figure 5 Source: Research Medical Center, 2011 (most recent publicly reported data); Cancer Quality Improvement Program (NQF 0219, 0559, 0220).
Advanced cancer-fighting technologies. Research Medical Center offers some of the most progressive cancer treatments in the region, including neurosurgeons trained to use the area’s only Gamma Knife® treatment for brain tumors (pictured on page 15), the only suite for high-dose rate (HDR) image-guided brachytherapy and the MammoSite® Radiation Therapy System. These technologies target cancer cells, limit the radiation exposure of healthy tissue, and deliver faster treatment and recovery times.
Innovative clinical trials. Together with Sarah Cannon, Research Medical Center brings more clinical research, more clinical trials and a broader range of cancer care services to Kansas City. Having conducted more than 140
Verda J. Hicks, MD, board-certified OBGYN and gynecologic oncology physician, advances minimally invasive surgery using the daVinci® robotic surgical system.
first-in-man clinical trials to date, Sarah Cannon is one of the largest early-phase research programs worldwide. Research Medical Center is also a partner in the National Cancer Institute Community Oncology Research Program, which brings access to additional clinical research trials. These partnerships make it possible for us to have trial opportunities in breast, gynecological, prostate, gastrointestinal, lung, head and neck, brain, thoracic, bone, skin, and blood cancers.
Improving Cancer Care Outcomes Mortality Rates Better Than National Averages
3.5% 3.0% In Hospital Deaths
3.3%
Better 2.7%
Syed Faisal Jafri, MD, board-certified gastroenterologist, consults on a broad range of cancer cases.
2.7%
2.5% 2.0%
1.6%
1.5% 1.0%
Research Medical Center
0.5% 0.0%
All CoC Programs Lung Resection
Pancreatectomy
Figure 6 Source: Research Medical Center, 2009-2011; Cancer Quality Improvement Program (n=1,200).
Multidisciplinary specialists gather for a clinical case conference at our Liver and Pancreas Institute.
9
PATIENTS FIRST
Genetic testing and counseling. Clinical leaders encourage early detection
Prestigious accreditation. Research Medical Center is accredited by
of cancer risk factors. Research Medical Center offers predictive gene
the CoC as a Community Hospital Comprehensive Cancer Program.
testing to give patients and families insight into their risks of developing
The CoC recognizes cancer care programs that carry out the mission of
cancer. Our four board-certified genetic counselors have 65 years
comprehensive, high quality and multidisciplinary care. Only facilities that
combined experience working with clinicians and patients to provide
accession at least 500 newly diagnosed cancer cases each year, provide a
personalized information about genetic influences, specific cancer risks,
full range of diagnostic and treatment services, and participate in cancer-
and targeted screening and prevention options.
related clinical trials are eligible for this accreditation. Through our CoC accreditation, we have access to reporting tools for benchmarking and
Liver and Pancreas Institute. Our Liver and Pancreas Institute (LPI) clinical
improving outcomes.
case conferences bring together a team of hepatologists, oncologists, radiologists, surgeons, and other physicians to shorten the time between
Oncology nursing excellence. Research Medical Center exceeds CoC
diagnosis and treatment for our patients. Patients with even the most
recommendations for specialty nurse staffing. Half of our nurses treating
complex cases receive a treatment plan the same day.
cancer patients have also attained the Oncology Nursing Certification, which is a formal recognition of standards in skill and experience that promote healthy outcomes.
Strengthening the Patient Experience
Industry evidence suggests a strong emphasis on nursing and nurse
Oncology Nurse Communication with Patients Improves, Exceeds National Average
100%
% of Patients
80%
proud to see nursing excellence reflected in our cancer center patient
Better
77%
75%
76%
84%
84%
satisfaction scores. In the area of communication – how well our oncology
79%
nurses communicate with and listen to patients – we exceeded the
60%
national average in 2014 (Figure 7), a testament to the “patients first”
40%
philosophy we embrace across the organization.
20%
Research Medical Center National Average
0% 3Q2013
4Q2013
1Q2014
2Q2014
3Q2014*
Figure 7 Source: Research Medical Center, 2014; Hospital Consumer Assessment of Healthcare Providers and Systems: Percentage of patients who responded “always” related to satisfaction with communication with nurses. *Through September 2014
10
communication is central to all gains in patient experience. We are
Excellence in Nursing Research shows positive work environments where nurses can flourish have healthy downstream effects on quality of care and patient satisfaction. Through the Pathway to ExcellenceŽ credentialing program, we have implemented a series of evidence-based practice standards known to improve nurse satisfaction, retention and recruitment. As we strengthen the 12 Pathway Practice Standards this year, our goal is to apply for the American Nurses Credentialing Center’s Pathway designation in 2015.
Our commitment to pursuing this achievement mirrors our commitment to true nursing excellence and recognition of the important contributions nurses make to quality healthcare and the entire patient experience.
A 110-year legacy of developing nursing excellence. The Pathway to Excellence credentialing program is relatively new, but our strengths in nursing are anything but. In 2015, Research College of Nursing is celebrating its 110th
Nurses at Sarah Cannon at Research Medical Center provide patient care excellence, which is reflected in our patient satisfaction scores.
anniversary, having grown substantially since its inception in 1905 with only five students, to more than 400 students today. Despite this growth in enrollment, the nursing college maintains an 8:1 student-faculty ratio that fosters rich academic and clinical discussions, and provides wide-ranging opportunities for nursing student research. Leading the way for patient care excellence despite nursing shortages, in 1991 the school became one of the first in the country to offer an accelerated program. Throughout its 110-year history, more than 4,000 professional nurses have graduated from Research College of Nursing.
Positive work environments allow nurses to flourish at Research Medical Center.
11
Above All Else
RAPID RESPONSE AND EFFICIENCY Heart Care | Stroke Care | Pain Care
When Lorraine Jones, 43, arrived at Research Medical Center, she was clinging to life after resuscitation from sudden cardiac death. The cardiology team moved quickly to provide advanced cardiac care, and despite the severity of her condition, Lorraine survived. After two weeks in the ICU, two surgeries and a total hospital stay of 23 days, she was strong enough to go home. “I was nearly dead when they carried me in, but I walked out,” Lorraine says. “That speaks volumes about the life-saving care they provide.” Willie E. Lawrence, Jr., MD, FAHA, FACC is board certified in cardiovascular disease and specializes in interventional cardiology.
Lorraine Jones (left) with her mother Marjorie Having witnessed the skill and devotion of the cardiac team firsthand, Marjorie says it often felt like Lorraine was getting special treatment. Now, she says, “I understand it was nothing out of the ordinary – every patient gets that VIP treatment at Research Medical Center.”
13
RAPID RESPONSE AND EFFICIENCY
Excellence in Heart Care
Excellence in Stroke Care
Cardiovascular disease is the number one killer of men and women in the
Time is critical when someone has a stroke, and Research Medical Center
U.S. As an accredited Cycle IV Chest Pain Center with PCI (Heart Attack
is a local leader in prompt, effective, high quality stroke care. As the first
Care), our highly skilled cardiologists provide round-the-clock, emergency
Certified Primary Stroke Center in the region, we provide interventional
heart care that exceeds national guidelines. Rapid response and efficiency
stroke care with the most advanced and effective treatments available.
in cardiac care are demonstrated through quality measures like door-
Our stroke care team includes physician specialists who perform clot
to-balloon time – that is, how long it takes to unblock an artery through
retrieval using the latest devices and technologies.
balloon angioplasty from the moment a patient enters the emergency room doors. At just 56 minutes, our average time is currently well below
Quality outcomes. As one of Kansas City’s largest high acuity hospitals,
the national guideline of 90 minutes (Figure 8).
we treat more patients with very serious, life-threatening health issues than most other area hospitals. Despite this fact, mortality rates for
Timely and effective heart attack care. In 2014, Research Medical Center
neuroscience patients treated at Research Medical Center are much lower
excelled at all eight core measures for heart attack care. This represents
than expected (Figure 9).
exceptional compliance with all treatment steps recommended by the Centers for Medicare and Medicaid Services (CMS) for timely and effective heart attack care.
Exceeding Standards for Door-to-Balloon Times 90
90 current average
80 70
Minutes
56
Better
2014
63
60
Improving Neuroscience Outcomes 90
55.9
58
56
50 40 30
14
1.6 1.4 1.2
Research Medical Center
10
National Guideline
2011
2012
2013
2014*
Figure 8 Source: Research Medical Center, 2014; GWTG, American Heart Association. *Through September 2014
Research Medical Center Neuroscience Mortality Rates
Better
1.43 1.24
1.0 0.8
Expected
0.87
0.78 0.62
0.6 0.4 0.2 0
20
0
Mortality Rates Better Than Expected Levels
In-Hospital Mortalities
90
90
2010
2011
2012
2013
2014*
Figure 9 Source: Research Medical Center, 2014; Neuroscience MS-DRGs per U.S. News & World Report Methodology; American Stroke Association. Expected levels are established based on the high severity of illness associated with neuroscience patients at Research Medical Center. *Through September 2014
Award-winning speed and efficiency. As a regular recipient of GWTGStroke Gold Plus with Target Honor Roll recognition, we consistently rise to a higher standard of care for our stroke and transient ischemic attack (TIA) patients (Figure 10). The American Heart Association’s current guidelines for treatment include an intravenous (IV) t-PA procedure with a key measure known as door-to-needle time. Lower door-to-needle times are associated with decreased morbidity and mortality, and in 2014 Research Medical Center met the national guideline of 60 minutes. In terms of functional recovery, the majority of our stroke patients return home or continue onto rehabilitation therapy after discharge.
Excellence in Pain Care The Center for the Relief of Pain is a unique component of our comprehensive Neuroscience Institute. Led by internationally recognized neurosurgeon William Rosenberg, MD, the Center for the Relief of Pain manages complex pain through advanced interventional techniques and integrative therapies.
Iftekhar Ahmed, MD, board certified in neurology and psychiatry, is Medical Director of the Stroke Care Center and TIA Clinic at the hospital.
The Center is dedicated to improving each patient’s quality of life through evidence-based care and patient education.
Exceeding Expectations for Ischemic Stroke Outcomes
In-Hospital Mortalities
Mortality Rates Better Than Expected Levels
1.6 1.4 1.2
1.45 1.27
Better
Research Medical Center Ischemic Stroke Mortality Expected
1.0 0.8
0.71
0.74
0.6
0.46
0.4 0.2 0
2010
2011
2012
2013
2014*
Figure 10 Source: Research Medical Center, 2014; CMS ICD-9 codes; GWTG, American Heart Association and American Stroke Association. *Through September 2014
Board-certified neurosurgeons Jonathan D. Chilton, MD (left) and Geoffrey L. Blatt, MD (right) specialize in comprehensive neurosurgeries, including Gamma Knife radiosurgery (pictured above).
15
Above All Else
PERSEVERANCE AND INNOVATION Transplant Care
When Willie McFail was diagnosed with kidney failure, he found himself hooked up to dialysis several hours a week. Knowing how hard it was, his brother Charlie gave him a second chance by becoming a living donor. Under the care of transplant surgeon Daniel Murillo, MD and transplant nephrologist Pranav Dalal, MD, Charlie underwent a laparoscopic procedure to donate his kidney to Willie at Research Medical Center last May. When asked by a local news station what his brother’s gift meant for him, Willie’s answer was simple but powerful: “Life.”
Pranav Dalal, MD, board-certified nephrologist (left) and Daniel Murillo, MD, board-certified surgeon (right) discuss patient outcomes at The Transplant Institute.
McFail Brothers, kidney recipient and donor Willie McFail (right) shares a laugh with his younger brother and living kidney donor Charlie (left). The brothers are pictured here in their hometown of Sedalia, Missouri, six months after the transplant that restored Willie’s quality of life and freed him from dialysis.
17
PERSEVERANCE AND INNOVATION
Excellence in Transplant Care
Kidney Transplant Patient Volume 70
nationally recognized kidney transplant program, as well as one of the area’s
60
4
4
only simultaneous kidney/pancreas transplant programs. In its 30-year history,
50
57
55
the kidney and kidney/pancreas transplant teams have performed 1,368 organ transplants (Figure 11). More than half of those transplants (740 to date)
# Patients
The Transplant Institute at Research Medical Center serves the region with a
have been performed since 2003 under the direction of Daniel Murillo, MD,
In 2012, The Transplant Institute earned the prestigious Medal of Honor for
30 20 10
Medical Director. In 2014, the kidney transplant team performed a total of 62 transplants.
40
0
5
3
51
52
Simultaneous Pancreas and Kidney Transplants Kidney Transplants
2011
2012
2013
2014*
Figure 11 Source: Research Medical Center, 2014. *Through September 2014
Organ Donation from the U.S. Department of Health and Human Services for exceeding national organ donation rates. Today, we transplant seven percent more kidneys than expected based on the high acuity level of patients seen here (Figure 12). Clinical evidence shows patients who receive transplantation
Exceeding Expectations in Transplant Volume Kidney Transplant Rates Higher Than National Levels
at higher volume hospitals like Research Medical Center are more likely to
Quality outcomes. By offering options for the rapidly growing number of end-stage renal disease patients who require dialysis or transplantation for survival, The Transplant Institute fills a serious role in the American healthcare system. Multidisciplinary physicians and nephrologists work with transplant recipients before, during and after surgery to assure high-quality outcomes for patients. The Transplant Institute’s success in kidney transplants is demonstrated by patient survival rates and graft survival rates, which exceed national averages for one month and one year post-transplant (Figure 13).
30% % Kidney Patients Receiving Transplants
have better outcomes.
Better 24%
25%
Expected
20% 16% 15% 10% 5% 0%
National
Research Medical Center
Figure 12 Source: Research Medical Center, 2013; Scientific Registry of Transplant Recipients. The percentage of kidney patients on the transplant waitlist who receive a transplant at Research Medical Center exceeds the national average among U.S. kidney transplant programs.
18
Living donor program. Kidneys from living donors generally function longer and are associated with higher success rates than kidneys from deceased donors. The Transplant Institute offers an active living donor program, with a laparoscopic procedure for recovering organs from living donors, and Research Medical Center operates a dedicated transplant unit for posttransplant care.
Kidney/pancreas program. With one of the few simultaneous kidney/pancreas programs in the region, Research Medical Center specializes in care for patients suffering from a variety of liver, pancreas or biliary tract diseases or disorders. Our nationally recognized transplant program has earned a reputation for excellent surgical skill, multidisciplinary care, advanced research and outstanding patient success rates.
Expanding access in Kansas and Oklahoma. In 2014, Research Medical Center partnered with Wesley Medical Center to fulfill a need for patient access to
Gena Soto, RN, transplant nurse, educates a patient about transplant medications.
pre- and post-transplant care in the large region surrounding Wichita. We have also performed transplants on patients from Oklahoma.
Delivering Excellence in Transplant Outcomes Graft Survival and Patient Survival Rates Meet and Exceed National Averages
% Post Transplant Survival
100%
99.24% 99.12%
98.29% 98.23% Better Graft Survival Rate (Living Donor/Diseased Donor)
95%
Patient Survival Rate (Living Donor/Diseased Donor) National Rate
90%
1 month 1 year Length of Time Post-Transplant
Figure 13 Source: Research Medical Center, 2013; Scientific Registry of Transplant Recipients, July 2011 through December 2013 (most recent publicly reported data).
Physician specialists and transplant professionals meet regularly to discuss evidence-based care for each patient.
19
Above All Else
TEAMWORK AND DETERMINATION Trauma Care | Emergency Medicine | Neonatal and Obstetrical Care | Reproductive Medicine
At 15 weeks pregnant, Aiden’s mother Amie was in a car accident that caused massive head trauma, broken bones and lacerated organs. LifeFlight Eagle transported her to our Level I Trauma Center, where physicians from 20 specialties worked collaboratively to keep Amie and her unborn son alive. The 4West nursing team provided attentive care and life support for the next four months, and despite the extreme severity of her condition, Amie gave birth to Aiden at 33 weeks gestation. He spent 34 days in the NICU before starting his new life outside the hospital as a healthy, happy baby boy.
Nurses Ruth Woronick, RN (left), Pat Conley, RN (right) and Norma Bolling, RN (seated) discuss patient care on 4West.
Aiden King and Scott Bjerke, MD Aiden is pictured here at six months old with Scott Bjerke, MD, Medical Director of Trauma Services. As a board-certified surgeon and fellowship-trained traumatologist, Dr. Bjerke led the coordinated effort that crossed multiple specialties and disciplines to save Amie and baby Aiden after a devastating car accident.
21
TEAMWORK AND DETERMINATION
Excellence in Trauma Care According to the Centers for Disease Control and Prevention, three out of
Caring for More Trauma Patients Volume Continues to Grow
1400
Since 2011, Research Medical Center has been offering the highest level of
1200
comprehensive trauma care as a Level I Trauma Center for acutely injured
1000
patients in our region. Our comprehensive center of excellence for burn care – the Grossman Burn Center, opened in 2013.
# of Patients
every four deaths among young people are the result of injuries and violence.
0
rehabilitation. Under the direction of Scott Bjerke, MD, fellowship-trained
rural areas, arriving by helicopter or emergency ground transport.
600
200
24-hour total care for every aspect of injury, from prevention through
year (Figure 14). Approximately 20 percent of our trauma patients come from
765
736
672
1065
400
As a Level I Trauma Center, Research Medical Center provides
traumatologist, we admit more than 1,000 patients with severe injuries per
800
1169
1070
Activations Total Patients
2012
2013
2014*
Figure 14 Source: Research Medical Center, 2014. Activations are defined as severely injured patients for whom the trauma team are activated; total patients include activations plus patient consults required regardless of activation. *Through September 2014
Quality outcomes. Determination and teamwork drive a multidisciplinary team of in-house critical care and trauma-trained, board-certified surgeons
Improving Trauma Care Outcomes
who provide critical care within 15 minutes of arrival. Together with critical
Mortality and Complication Rates Better Than Expected Levels
8.0%
neurosurgery, anesthesiology, emergency medicine, radiology, and internal
7.0%
medicine, the trauma team works tirelessly to improve survival rates and
6.0%
lower costs associated with medical care and work loss. Based on the number of patients in the trauma registry and their acuity, it is expected Research Medical Center would have a complication rate of 4.4 percent. However, our actual complication rate is only 3.8 percent and our mortality rate is 5.0 percent, both below expected levels (Figure 15).
% of Patients
care nurses, support staff and specialists in critical care, orthopedic surgery,
5.0% 4.0%
Better
Research Medical Center Expected
5.1% 5.0%
4.4% 3.8%
3.0% 2.0% 1.0% 0.0%
22
Mortality
Medical Complications
Figure 15 Source: Research Medical Center, 2013; Diagnosis codes for major medical complications for trauma, injury and poisoning. Expected levels are based on the high severity of illness associated with trauma patients at Research Medical Center.
Excellence in Emergency Care Every second matters in an emergency – that’s why Research Medical Center offers round-the-clock emergency care. Board-certified physicians, critical care nurses, and support staff ensure that emergency patients are triaged at arrival and seen by a qualified medical professional in priority order. On average, our emergency department sees more than 63,000 patients each year at our main hospital and Brookside campuses.
Increased access to emergency care. To ensure timely, convenient emergency Megan L. Garcia, MD, board-certified surgeon, treats patients at the Grossman Burn Center, a specialized center for comprehensive acute and reconstructive burn care.
care, we actively measure and manage patient wait times, which are well below national averages (Figure 16). Because efficient emergency care translates to more optimal outcomes, we have implemented continuous quality improvement initiatives to maintain low wait times. As a result, we have significantly reduced the number of patients who leave our emergency department without being seen. At our main hospital campus, this rate has fallen from 4.4 percent in January 2013 to just 0.1 percent today – below the national average of two percent.
Providing Timely Emergency Care Patients Receive Care Faster as Arrival-to-Greet Time Improves
30 25 Minutes
Better
29.7 22.5
23.8 21.1
20
18.5
19.9
16.6
15 10
Research Medical Center Brookside Campus National Average (24 min) Top 5th Percentile (12 min)
Teamwork drives low wait times in emergency care. Left to right: Cassandra Montoya, PA-C, Jason W. Eppler, MD and Robyn Miller, Director of Emergency Services.
7.59
8.23
8.32
8.88
Jan
Feb
Mar
Apr
7.88
9.48
12.65
11.64
7.8
7.7
8.65
Jul
Aug
Sep
5 0
May
Jun
Figure 16 Source: Research Medical Center, 2014; Hospital Compare, CMS. *Through September 2014
On average, LifeFlight Eagle transports more than 225 patients annually to Research Medical Center.
23
TEAMWORK AND DETERMINATION
Excellence in Neonatal Care
care. Following a multidisciplinary collaborative quality improvement
The availability of neonatal intensive care has improved outcomes for
model, our neonatal team eliminated central line-associated bloodstream
high-risk infants like Aiden King, who are born either preterm or with
infections (CLABSI) in the NICU. CLABSI is a high-cost adverse event and
serious medical or surgical conditions. Our 19-bed, Level III Neonatal
significant contributor to neonatal mortality because these patients have
Intensive Care Unit (NICU) provides subspecialty care for the tiniest, most
immature immune systems.
vulnerable patient population: critically ill newborn infants.
Excellence in Obstetric Care
Our Level III NICU cares for infants born as early as 23 weeks (four
Cesarean sections and early elective deliveries come with added health
months premature) through full term. The nursery is staffed with
risks for mothers and babies. Our care teams in obstetrics have improved
highly specialized neonatologists, neonatal nurse practitioners, nurses,
quality, safety and performance by implementing evidence-based
respiratory therapists, lactation consultants and social workers. Advanced
practices to assure low C-section rates. With the national C-section rate
equipment supports newborns with respiratory difficulties or other high-
remaining above 30 percent, we consistently perform below national
risk complications (Figure 17).
averages on C-sections for first-time pregnancies (primary C-section rate), as well as total pregnancies (Figure 18). Research Medical Center was
Neonatal quality outcomes. Research Medical Center has made
honored in 2014 by March of Dimes for decreasing early elective deliveries
measurable improvements in the quality and cost of neonatal intensive
to zero as of August 2014 (Figure 19).
Highly Specialized Level III NICU
Obstetric Outcomes C-Section Rates Better Than National Averages
Neonatologists, neonatal nurse practitioners Specialized nurses, respiratory therapists Radiology and lab technicians Portable X-ray machine Blood gas analyzer
17.96%
National Average
30% 10.58%
2014* 8%
2013
Sustained life support Full range of respiratory support Access to full range of pediatric medical and surgical subspecialists
2011
Advanced imaging capabilities
2010
Comprehensive care for all critically ill infants born at any gestational age or birth weight Figure 17 Source: American Academy of Pediatrics, 2012.
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0%
19.2%
9%
2012
17.8%
9%
17.6%
10% 5%
20.93%
10%
16.8% 15%
20%
Better Research Medical Center Primary C-Section Rate Research Medical Center Total C-Section Rate
25%
30%
35%
Figure 18 Source: Research Medical Center, 2014; Agency for Healthcare Research and Quality national average for inpatient quality indicators #33 and #21. *Through September 2014
Excellence in Reproductive Medicine From saving lives to giving life, we are committed to our philosophy of touching lives with hope, healing, comfort and care. We complement cuttingedge diagnostic and treatment technology with highly specialized and skilled physicians who translate research and evidence-based best practices into advanced life-giving techniques.
Women seeking in vitro fertilization (IVF) choose Research Medical Center for our success rates, a measure known as clinical pregnancy rates (CPR). Our affiliated women’s care practice, Midwest Women’s Healthcare Specialists, outperforms IVF centers both locally and nationally with a 65.2 percent CPR for women under 35. By comparison, the national CPR rate in 2012 was only 47 percent. Neonatal nurse practitioners and nurses provide subspecialty care in our Level III NICU.
Optimal Obstetric Outcomes Early Elective Deliveries Remain Low
20%
17.0% 14.0%
15% % of Patients
Better
11.2%
Research Medical Center National Average
10% 4.6%
4%
5% 0%
0%
2.4%
0%
0% 2010
2011
2012
2013
Figure 19 Source: Research Medical Center, 2014; The Leapfrog Group (most recently publicly reported data).
Board-certified OBGYN physician Gregory C. Starks, MD, a renowned specialist with more than 30 years’ experience, leads our Fertility and Family Planning program.
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Above All Else
HEALTH AND WELLNESS Wellness at Work | Health Insurance
To succeed in our continuous journey of healthcare excellence, we firmly believe in exchanging ideas and input with our local community leaders. As part of this commitment, we held our first Community Advisory Board meeting last November. At the inaugural session, Jackie DeSouza-Van Blaricum, President and CEO, shared our goals and achievements in health and wellness with Kansas City business leaders, while hospital executives and physicians spoke about our bold quest to be the best healthcare provider and healthcare employer in the region.
At a recent Town Hall meeting, Jackie DeSouza-Van Blaricum shares patient satisfaction reports with the patient transportation team.
Jackie DeSouza-Van Blaricum and Ted McKnight Jackie DeSouza-Van Blaricum and Ted McKnight, a broker at CBIZ, Inc., share ideas for building healthier workplaces at a recent Community Advisory Board meeting. Discussions spanned topics such as advances in cancer care and research, health and wellness, and health insurance.
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HEALTH AND WELLNESS
Workplace Health
initiatives to help employees learn how to reduce health risks before
With employee healthcare costs continuing to rise, employers turn to
chronic or major conditions develop. Other employers offer our health
Research Medical Center for resources that improve employee health and
and wellness educational services to their employees in the workplace.
stem costs associated with absenteeism and reduced productivity. For
Available onsite as health education and online as wellness screenings,
many employers, the biggest obstacle to achieving a healthier workforce
tools are readily available for employers and individuals to influence
is employee engagement, so our workplace health programs include
healthier lifestyle changes such as quitting smoking, losing weight,
targeted engagement strategies to generate interest and participation that
increasing fitness levels, or managing diabetes and other chronic
brings results.
diseases.
Wellness at Work. Through our Wellness at Work program, Research
Because our vision for Research Medical Center includes initiatives that
Medical Center works with local employers to create a healthier Kansas
address the needs of our people, we offer our own employee wellness
City. Our Wellness at Work program includes programs and tools to encourage and support employees as they pursue healthier lifestyles. Our goal is to equip employers with the means to help improve employee health, which in turn leads to lower healthcare costs for the firm and the employees.
Workplace Health Programs Lifestyle management weight nutrition stress management
Through the following program components, Wellness at Work directly addresses employers’ health-related goals in the workplace by offering the following: • Online and risk-based screenings that may identify employee health
smoking cessation Disease management targeted health intervention for chronic diseases such as coronary artery disease, hypertension and diabetes
risks early • Timely access to primary care physicians and other providers for annual
Sports management
wellness visits and urgent healthcare needs
sports injury prevention
• Targeted engagement strategies that increase employee involvement
injury treatment
• Targeted education and interventions that encourage accountability and impact poor employee health habits • Best-in-class health solutions delivered in partnership with health plans, employee benefit brokers and/or local community resources
Employee and work place health post-offer and pre-employment screenings return to work services healthcare experts to address prevention to intervention across a range of conditions
Many organizations in Kansas City use our education and wellness
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programs. Studies show a positive correlation between employee wellness and the organization’s reputation, overall performance and cost of care – three factors that can also have a direct or indirect impact on patient satisfaction. By promoting and supporting healthier lifestyles among the people who work at our healthcare campuses, we aim to improve satisfaction levels of our employees and patients alike.
Founded on evidence-based principles, Wellness at Work influences positive health behaviors for participating Kansas City-area employers. Financial return for employers comes from helping high-risk employees increase their health awareness and accountability through relevant and accessible health education, seminars and coaching, and keeping healthy employees fit and active. We also encourage employers to educate their staff about the importance of annual wellness visits with a primary care physician and other recommended healthcare providers.
Stephen C. Salanski, MD, Program Director of the Research Family Medicine Residency, trains 2014 resident Suzanne Ozborn, MD.
Health insurance premium reduction programs. At Research Medical Center, we have implemented a health insurance premium reduction program to reward our employees for meeting wellness goals. Such financial incentives are encouraged by the Affordable Care Act (ACA). ACA supports participatory workplace wellness programs, such as fitness center reimbursements for positive participation in health seminars, risk assessments and other wellnessrelated activities. Some employers offer non-discriminatory, health-contingent wellness programs tied directly to individual performance to specific health goals.
Research Medical Center’s health and wellness programs extend from workplace to community.
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ACCREDITATIONS AND HONORS
Awards & Honors 2014 Top Hospital Research Medical Center is the only hospital in Kansas City to earn the prestigious Top Hospital distinction from The Leapfrog Group in 2014. Nationwide, only 94 hospitals achieved this honor, and among them, only 60 were similar in size to Research Medical Center. Top Performer on Key Quality Measures® 2013, 2012 For the past two years, Research Medical Center has earned national recognition as a Top Performer on Key Quality Measures by The Joint Commission. Our Top Performer awards, which are based on 2013 and 2012 hospital performance data, represent our exemplary care for heart attack, heart failure, pneumonia and surgical patients. “A” Grade Hospital Safety Score, 2014 The Leapfrog Group evaluates hospital data to assign a letter grade rating that represents how well each hospital protects patients from accidents, infections, injuries, and errors. Research Medical Center proudly achieved a top “A” grade rating in 2014.
TA R G E T: H F H O N O R R O L L
2014 Get With The Guidelines® Heart Failure – Gold Plus Honor Roll For the second year in a row, the American Heart Association has recognized Research Medical Center for exceptional heart failure care. This award confirms our consistent adherence to GWTG performance achievement indicators and quality measures. 2014 Get With The Guidelines® Stroke – Gold Plus with Target Honor Roll 2014 marked the second consecutive year that Research Medical Center was recognized by The American Stroke Association for exceptional stroke care. This award confirms our consistent adherence to GWTG performance achievement indicators and quality measures. 2014 Mission: Lifeline® – Bronze Research Medical Center received the Mission: Lifeline award from The American Heart Association for demonstrating consistent adherence to all performance achievement indicators and quality measures to improve the quality care for ST-elevation myocardial infarction (STEMI) patients.
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2014 Leader in LGBT Healthcare Equality Research Medical Center earned top marks from the Human Rights Campaign (HRC) Foundation for our commitment to equal care for lesbian, gay, bisexual and transgender (LGBT) patients. We are among just 426 hospitals nationwide to receive distinction as a Leader in LGBT Healthcare Equality in 2014, which is based on findings from HRC’s annual Healthcare Equality Index. 2014 March of Dimes Recognition For decreasing early elective deliveries (EEDs) to zero in 2014, Research Medical Center was honored by the March of Dimes as part of their Healthy Babies are Worth the Wait® (HBWW) initiative. The goal of HBWW is to give babies a stronger start in life by encouraging the prevention of EEDs, or non-medically necessary deliveries before 39 weeks gestation. 2013 ACTION Registry® – GWTG™ Platinum Performance Achievement Research Medical Center consistently followed treatment guidelines set forth in the ACTION Registry– GWTG Premier for eight consecutive quarters and met a performance standard of 90 percent for specific performance standards. 2012 HHS Organ Donation Silver Medal of Honor The U.S. Department of Health and Human Services awarded the Silver Medal of Honor to Research Medical Center for achieving at least a 75 percent organ donation rate from eligible donor families in a consecutive 12-month period. 2013 UDSMR Top Performer Award For excellence in acute rehabilitation services, Research Medical Center earned the Top Performer Award from Uniform Data Systems for Medical Rehabilitation (UDSMR). This achievement is based on 2013 performance data that placed us in the 92nd percentile among nearly 800 qualifying facilities nationwide.
Accreditations & Certifications Hospital Accreditation Research Medical Center earned The Joint Commission’s Gold Seal of Approval® for accreditation by our continuous dedication to compliance with The Joint Commission’s state-of-the-art standards for healthcare quality and safety in hospitals.
•
•
Advanced Certification in Heart Failure Research Medical Center received advanced certification from The Joint Commission for demonstrating that we meet the requirements for Disease-Specific Care Certification, plus additional, clinically specific requirements and expectations. Chest Pain Center Accreditation with PCI The Accredited Chest Pain Center at Research Medical Center earned accreditation from The Society of Cardiovascular Patient Care by demonstrating our expertise and commitment to quality patient care in multiple key areas. Certified Cardiac Rehabilitation Program The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) certifies our cardiovascular and pulmonary rehabilitation program offers the most advanced practices available and provides the appropriate and effective early outpatient care of patients with cardiac or pulmonary issues. Advanced Certification in Stroke (Primary Stroke Center) Research Medical Center received an advanced certification from The Joint Commission for our programs that meet the requirements for Disease-Specific Care Certification, plus additional, clinically-specific requirements and expectations. Vascular Testing Accreditation Research Medical Center received a “seal of approval” by medical experts in the field of Vascular Testing for our accreditation by The Intersocietal Accreditation Commission. Level I Trauma Center in Missouri Research Medical Center earned Level I Trauma Center status, the highest designation available, from The Missouri Department of Health and Senior Services for our 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, and critical care.
National Accreditation Program for Breast Centers (NAPBC) National Accreditation Program for Breast Centers (NAPBC), the gold standard for breast center accreditation, recognizes Research Medical Center for our commit to providing the best possible comprehensive care to patients with diseases of the breast. Breast Imaging Center of Excellence Our Breast Imaging Center of Excellence designation recognizes that we have earned accreditation in mammography, stereotactic breast biopsy, and breast ultrasound (including ultrasound-guided breast biopsy). Mammography Accreditation The gold seal of accreditation from the American College of Radiology (ACR) represents the highest level of image quality and patient safety. Following peer-review evaluations by board-certified physicians and medical physicists, Research Medical Center earned the ACR gold seal of accreditation for mammography. Computed Tomography Accreditation For meeting ACR Practice Guidelines and Technical Standards as demonstrated in a peer-review evaluation, ACR awarded the gold seal of accreditation to Research Medical Center for computed tomography. MRI Accreditation For meeting ACR Practice Guidelines and Technical Standards as demonstrated in a peer-review evaluation, ACR awarded the gold seal of accreditation to Research Medical Center for Magnetic Resonance Imaging (MRI). Ultrasound Accreditation For meeting ACR Practice Guidelines and Technical Standards as demonstrated in a peer-review evaluation, ACR awarded the gold seal of accreditation to Research Medical Center for ultrasound imaging. Nuclear Medicine Accreditation For meeting ACR Practice Guidelines and Technical Standards as demonstrated in a peer-review evaluation, ACR awarded the gold seal of accreditation to Research Medical Center for nuclear medicine.
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RESEARCH MEDICAL CENTER FACILITIES
Research Medical Center 2316 E. Meyer Blvd Kansas City, MO 64132 Phone: (816) 276-4000
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Research Psychiatric Center 2323 E. 63rd Street Kansas City, MO 64130 Phone: (816) 444-8161
Research Brookside Campus 6601 Rockhill Road Kansas City, MO 64131 Phone: (816) 276-7000
METHODS AND FOOTNOTES
Executive Team
Hospital Consumer Assessment of Healthcare Providers and Systems
Jackie DeSouza-Van Blaricum, Chief Executive Officer
www.hcahpsonline.org/home.aspx
Lisa St. Aubyn, Chief Executive Officer, Research Psychiatric Center
Scientific Registry of Transplant Recipients (SRTR)
James Bower, MD, Chief Medical Officer
www.srtr.org
Paige Baker, RN, MSN, Chief Nursing Officer
The Advisory Board Company: Crimson Continuum of Care
John Krajicek, Chief Financial Officer
www.advisory.com/technology/crimson-continuum-of-care
Eric Becker, Chief Operating Officer
The Leapfrog Group www.leapfroggroup.org
Methodology Research Medical Center collects internal, patient-level data based
Acknowledgments
on the Centers for Medicare & Medicaid Services Diagnostic Related
Above All Else Quality Report is published by Research Medical Center.
Group (MS-DRG) classification system and International Classification
Project Leaders: Corrine Everson, Vice President of Marketing, and
of Diseases (ICD) codes. Detailed data indicate the volume of Medicare
Megan Fischer, Vice President of Quality Improvement
patient discharges, mortality, lengths of stay, charges and costs, as well
Photography: Mark McDonald
as the associated severity code for each DRG. Standards and Data Sources Data are compared to state and national averages for the most recent publicly reported period. Where possible, Research Medical Center has reported 2014 data through the third fiscal quarter (September 2014). Publicly reported standards and data sources include: Agency for Healthcare Research and Quality www.ahrq.gov American College of Surgeons Trauma Quality Improvement Program (TQIP速) www.facs.org/quality-programs/trauma/tqip American Heart Association/American Stroke Association Get With The Guidelines速 www.heart.org Core Outcome Measures in Effectiveness Trials (COMET) Initiative www.comet-initiative.org Hospital Compare www.medicare.gov/hospitalcompare
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Top Hospital, The Leapfrog Group, 2014
Leader in LGBT Healthcare Equality, 2014
“A” Grade Hospital Safety Score, The Leapfrog Group, 2014
ACTION Registry® – GWTG™ Platinum, 2013
TA R G E T: H F H O N O R R O L L
Get With The Guidelines® Heart Failure – Gold Plus Honor Roll, 2014
UDSMR Top Performer Award, 2013
Get With The Guidelines® Stroke – Gold Plus with Target Honor Roll, 2014
Top Performer on Key Quality Measures® 2013, 2012
Mission: Lifeline® – Bronze, 2014
HHS Organ Donation Silver Medal of Honor, 2012
2316 E. Meyer Blvd Kansas City, MO 64132 (816) 276-4000 ResearchMedicalCenter.com ©2015 Research Medical Center