How a Las Vegas Hospital United ED Docs with Hospitalists to Reduce ED Overcrowding

By | Advancements, Hospitals, Innovation

Sunrise Hospital & Medical Center’s integration created a ‘one team’ culture

Like many hospitals, Sunrise Hospital & Medical Center, Las Vegas was receiving more patients in its emergency department than it was equipped to manage regularly.

One of the largest Medicaid providers in Nevada and situated minutes from the rowdiness of the Las Vegas Strip, Sunrise was struggling with hold hours in its ED. In its worst month, the hospital experienced 28,000 hold hours, with the normal average nearing 20,000 per month, says Alan Keesee, COO, Sunrise Hospital & Medical Center.

Ever since the passage of the Affordable Care Act, and Nevada’s decision to expand Medicaid, Sunrise’s utilization of emergency services has increased double-digits each year. Last year, the Las Vegas hospital received 157,000 ED visits, the largest in the state, by far, says Keesee. With well over half of those visits attributed to Medicaid patients, he added.

Something had to be done to ease the burden on providers. Keesee says leadership saw an opportunity to streamline processes and get patients up to the floors and reduce patients’ length of stay overall.

Sunrise decided to integrate its emergency department and hospital medicine teams into one — unifying them under a single medical director.

The result was a one-team, one culture philosophy, says Keesee. The hospital’s efforts to increase the number of providers through recruitment and the development of team-based models for observational patients and protocols as part of the integration has also helped reduce hold hours.

Whereas most hospitals have their observational patients spread across the facility, Sunrise created a 30-bed observation unit, and dedicated providers and case managers to oversee that unit and monitor results, which has helped increase the number of patients discharged prior to 11 a.m. to 50 percent, up from 10. These measures have also contributed to a one day decline in length of stay for patients.

And not only have those hold hours dropped 79 percent in the ED to 6,000 hours per month, but there has been a palpable change in culture and care. One of the most noticeable changes has come from a nursing standpoint, says Keesee. Nurses now know who is on a team that day, and trust has greatly improved since having a dedicated leadership team focused on shared goals. Nurses will call and text physicians, and are able to know who their doctor is that day, says Keesee. “It’s really increased overall nursing and physician collaboration,” he added.

Keeping the momentum going and avoiding old pitfalls is always a concern after a large integration. Keesee notes that in order to keep pushing forward, leadership needs to come together to continually look for areas to collectively improve.

“You can’t do that in a silo, just the ED, just the hospitalists, you have to really have all those voices at the table, to make the improvements [and] continue to move forward,” says Keesee.

“If you’re disconnected, as an administration, with your medical leadership it’s really hard to move the organization forward with patients.”

Dignity Health-St. Rose Dominican Receives Four 2017 Five-Star Ratings From Healthgrades

By | Hospitals, Press Releases, Recent Releases

Dignity Health-St. Rose Dominican today announced that it has received 5 stars for quality care in four service areas from Healthgrades, the leading online resource helping consumers make informed decisions in order to find the right doctor, the right hospital, and the right care. These service areas include:

  • –  Rose De Lima Campus:
    Esophageal/Stomach Surgeries (two years in a row)                                                                              Colorectal Surgeries (five years in a row)
  • –  Siena Campus:
    C-Section Delivery (two years in a row)
  • –  San Martin Campus:
    Esophageal/Stomach Surgeries

This achievement is part of new findings and data released today on Healthgrades.com and in the Healthgrades 2016 Report to the Nation. Every year, Healthgrades evaluates hospital performance at nearly 4,500 hospitals nationwide for 33 of the most common inpatient procedures and conditions.

The new report demonstrates how clinical performance continues to differ dramatically between hospitals both nationally and regionally. This variation in care has a significant impact on health outcomes. For example, from 2012 through 2014, if all hospitals as a group, performed similarly to hospitals receiving 5 stars as a group, on average 222,392 lives could potentially have been saved and 166,086 complications could potentially have been avoided.* A 5-star rating indicates that St. Rose’s clinical outcomes are statistically significantly better than expected when treating the condition or performing the procedure being evaluated.

“Receiving these ratings from Healthgrades means a great deal to St. Rose,” said Brian Brannman, senior vice president of operations for Dignity Health Nevada. “The ratings recognize what we continue to strive for – superior performance and outcomes for our patients.”

“The Healthgrades 2016 Report to the Nation reveals striking disparities in quality at the local level, and underscores why it is vital for consumers to understand outcomes performance at alternative hospitals for specific conditions and procedures,” said Evan Marks, Chief Strategy Officer for Healthgrades. “Hospitals with superior outcomes for certain aspects of care may not perform as well in other areas. Moreover, a major metropolitan area may have many hospitals, but only a few may provide better-than-expected outcomes for the specific care a patient needs. Those hospitals that have achieved the Healthgrades distinction have demonstrated a commitment to exceptional quality care.”

For its analysis, Healthgrades evaluated approximately 40 million Medicare inpatient records for nearly 4,500 short- term acute care hospitals nationwide, and assessed hospital performance relative to each of 33 common conditions and procedures. Healthgrades recognizes a hospital’s quality achievements for cohort-specific performance, specialty area performance, and overall clinical quality. Individual procedure or condition cohorts are designated as 5 star (statistically significantly better than expected), 3 star (not statistically different from expected), and 1 star (statistically significantly worse than expected) categories. The complete Healthgrades 2016 Report to the Nation with detailed cohort-specific outcomes data, hospital-specific quality achievements, and detailed study methodology, can be found at www.healthgrades.com/quality.

About Dignity Health-St. Rose Dominican

As the community’s only not-for-profit, religiously sponsored health system, Dignity Health-St. Rose Dominican has been guided by the vision and core values of the Adrian Dominican Sisters for more than 65 years. As the Henderson and Las Vegas communities grow, the three St. Rose Dominican hospitals (the Rose de Lima, Siena and San Martín Campuses) and more than 3,400 employees will continue the Sisters’ mission of serving people in need. St. Rose Dominican is a member of the 21-state Dignity Health network of nearly 11,000 physicians, 56,000 employees, and more than 300 care centers, including hospitals, urgent and occupational care, imaging centers, home health, and primary care clinics. For more information, visit our website at strosehospitals.org or follow us on Facebook, Twitter, YouTube or our Blog. St. Rose is hiring! To apply for an open position, visit our careers website.

*Statistics are based on Healthgrades analysis of MedPAR data for years 2012 through 2014 and represent 3-year estimates for Medicare patients only.

Addressing Critical Need, Nevada’s First Provider-Based ER Opens Today

By | Developments, Hospitals

ER at The Lakes – A Department of Southern Hills Hospital & Medical Center is Newest ER in Las Vegas

ER at The Lakes – A Department of Southern Hills Hospital & Medical Center is now open to patients  at 3325 S. Fort Apache Road. Nevada’s first provider-based emergency room will help to alleviate the chronic shortage of emergency treatment capacity in the Las Vegas Valley. ER at The Lakes will allow faster and more convenient access to medical care for thousands of southern Nevadans by providing full-service emergency and critical care services for adults and children.

Unlike many urgent care facilities, ER at The Lakes will be staffed 24 hours a day, seven days a week by board-certified emergency room physicians, nurses and other healthcare professionals providing most of the same services available at hospital emergency rooms, with significantly shorter wait times. The new facility includes 12 patient examination rooms, around-the-clock laboratory testing, X-ray, CT scanning and ultrasound, and a separate pediatric patients’ entrance. Patients who require additional emergent care will be admitted to affiliated hospitals.

“With Southern Nevada’s continued population growth, ER at The Lakes provides increased access points for patient-centered emergency care in our community,” said Adam Rudd, Chief Executive Officer (CEO), Southern Hills Hospital & Medical Center. “This new emergency room will provide the full spectrum of care using state-of-the-art diagnostic, monitoring and treatment equipment while delivering a high-quality patient experience in a convenient location.”

The new facility garnered approval from Senator Patricia Farley whose district ER at The Lakes is located: “It is refreshing that Southern Hills Hospital continues to search for innovative ways to deliver healthcare and does so without comprising the high level of care that we, as patients, expect,” said Farley.

About Southern Hills Hospital

Voted the Best Hospital in Las Vegas, Southern Hills Hospital provides the communities of southwest Las Vegas with emergency and pediatric emergency services, a behavioral health (geriatric psychiatric) inpatient and outpatient program serving ages 50 and older, an accredited Chest Pain Center, a Certified Primary Stroke Center, a dedicated orthopedic and spine unit, OB-GYN, Level II NICU, diagnostic imaging and surgical services. Utilizing advanced digital technology and an accomplished medical staff, Southern Hills Hospital’s advanced care and superior service make for better outcomes and an exceptional patient experience. The Joint Commission, the leading accreditor of healthcare organizations in America, recognized Southern Hills Hospital as a Top Performer on Key Quality Measures® for 2010, 2011, 2012, 2013 and 2014 – the only Nevada hospital to earn this recognition for five consecutive years. The hospital is a member of the respected Sunrise Health System consisting of Sunrise Hospital, Sunrise Children’s Hospital, MountainView Hospital and several surgery and diagnostic imaging centers offering a complete range of specialized and technologically advanced services. 

Southern Hills Hospital
9300 W. Sunset Rd.
Las Vegas, NV 89148

Henderson Hospital Opens Union Village

By | Hospitals

Southern Nevada will open its first new hospital in eight years when Henderson Hospital starts seeing its first patients the morning of Oct. 31.

The 130-bed facility on Galleria Drive adjacent to U.S. Highway 95 will be the sixth in the Valley Health System and first in the region since the company opened Centennial Hills Hospital in 2008.

All that remains is the final licensure by the state that’s expected to be completed the week of Oct. 17. The hospital will then open at 8 a.m. on Nevada Day.

With this opening, Valley Health System has most of the Las Vegas Valley covered. Its nearest hospital is Desert Springs Hospital, about 8 miles away.

“We like this location because it’s in Henderson, and we feel this community needs additional access to health care,” said Henderson Hospital CEO Sam Kaufman. “If you pinpointed a map, you could see what we were missing — the southeast corridor, that’s a very large market. We love the location by the freeway and love the anticipated growth with (master plan housing developments) Cadence, Lake Las Vegas and Tuscany. That’s along with being the anchor client of Union Village that will continue to grow over the next three, to five, to eight years.”

Henderson Hospital is the centerpiece of Union Village, a $1.2 billion 170-acre planned community that not only covers health care, but housing, retail and entertainment.

Kaufman said a lot of Valley Health System’s managed care clients live in Henderson, and many don’t like to leave the Green Valley and Henderson area for their care.

“We have contracts with every single managed care organization in the community, and people live in … Green Valley and Henderson, and they don’t like to travel outside of Green Valley and Henderson,” Kaufman said. “Having a hospital in Spring Valley doesn’t help you in Green Valley, and having a hospital in Desert Springs in the center of town doesn’t help you. This gives us an opportunity to be one-stop shopping for everybody.”

Kaufman said Valley Health System is the only health care system that is considered by all payers, even though it doesn’t have an exclusive arrangement. HCA and Dignity Health, meanwhile, are not on all-payer contracts, he said.

Valley is part of Universal Health Services of Delaware, and planning for the hospital started in 2012, Kaufman said. There’s nothing specific on the timing, except the company prefers to open hospitals in the fall before the busier winter months.

“When we started building this hospital, we were pulling out of the recession, and our company knew there would be additional access issues and that this hospital would have a very good chance of being successful.” Kaufman said. “I wish we would have done it years ago, but there’s really nothing specific on the timing. I guess we kind of got involved in this project once the Union Village concept was developed, and we partnered with Union Village to take this 30-plus-acre area to develop the anchor facility.”

Southern Nevada needs additional hospitals because access has been a problem, Kaufman said. People are waiting too long in emergency rooms, and he said there are horror stories of people not finding a bed or having trouble getting their surgeries scheduled.

The implementation of the Affordable Care Act has given more access to more people through Medicaid expansion and private insurance, and that means more people going to hospitals, Kaufman said.

“I think the timing is really good, and the residents of not only Henderson, but outlying areas like Boulder City and Arizona and California communities will benefit from the construction of this hospital,” Kaufman said.

Opening up a hospital has plenty of challenges from the construction, to the licensure, to the staffing of physicians and nurses, Kaufman said. The next phase is business development and operations, he said.

Henderson Hospital is opening with 130 beds in private rooms. It will open a 12-bed neonatal intensive care unit within the next year, Kaufman said. The infrastructure is in place for 30 shelved beds that will only need building out and the addition of equipment, he said.

“We could open these in six to eight months of putting in that business plan, and then that would put us at 172,” Kaufman said. ‘We have the ability to build additional towers with little to no disruption to the ongoing operations of the hospital.”

Kaufman said the hospital doesn’t have an immediate identity, but eventually it will specialize in women’s services. There will be a lot of specialties with surgical services that will grow over time. Henderson Hospital will add a da Vinci robot in the first or second quarter of 2017 for surgeries. It will open with four surgical bays in the hospital, and plans for two more in 2017 in an outpatient surgical center under construction.

“In the beginning we don’t have neurosurgery and open heart, and we will do everything else but those,” Kaufman said. “I don’t think we will ever migrate to heart because Desert Springs is only 8 miles away, and they have a huge cardiac program. I think one day we will migrate to neurosurgery. That’s a likely candidate for us considering that Desert Springs doesn’t have neurosurgery.”

Henderson Hospital is building a medical office building adjacent to it that will have 83,000 square feet with the second through fourth floors serving as doctors’ offices. The first floor will be an outpatient surgery center and outpatient wound center with hyperbaric oxygen treatment, Kaufman said. The shell will be completed by the end of the year, and tenant improvements should start in January, he said.

Henderson Hospital will bring in between 500 and 700 employees, depending on the volume, Kaufman said. Like at other hospitals, there are difficult positions to fill, especially in nursing. There are some vacancies in labor and delivery and a few in the emergency room and ICU, Kaufman said.

“To move a doctor or to move a nurse, people aren’t going to move if they’re happy where they are, “Kaufman said. “You need to give them a differentiating reason. It’s a bright, new, shiny penny. What’s going to separate this hospital from every other hospital is the type of care that people receive and the manner in which they receive it. We have some interesting technology in our hospital that differentiates us from other hospitals.”

For quality and patient safety, there are antimicrobial coatings on door -knobs, silver iodine-infused countertops, and a special lighting system in the operating room and C-section suites that kill bacteria, Kaufman said.

High-quality and safe patient care, however, isn’t enough, he added. That used to be what hospitals needed at one time, but now patients and their families want more.

“It’s not OK to have great nurses that are only clinically astute,” Kaufman said. “These nurses need to be compassionate, and really want to work and take care of patients.”

People will notice those differences and more when they come to the hospital, Kaufman said.

There’s an acoustic system that minimizes sound inside the hospital, the roof reduces noises and nursing hubs on floors are enclosed in glass to keep sounds inside when people are talking, he said.

Henderson Hospital purchased a communications system so the nurses can speak directly with doctors rather than go through an operator. It’s an attempt to minimize an overhead paging system, which patients don’t like, he said.

Henderson Hospital has a video wall that — with the patients’ permission — will show video of newborn babies and other footage on a 10-foot screen.

The hospital has artwork, including sculptures and photography depicting Henderson and the Southern Nevada desert and other landscape scenes.

“We have things no other hospital has,” Kaufman said. “You don’t see sculptures in any other hospitals. The artwork is beautiful and gives people a different perspective. It’s soothing for people.”

Kaufman has worked for Valley Health Systems for 25 years and has worked his way up the ladder. He served as director of departments at Desert Springs and Valley hospitals. He worked as an assistant administrator for five years at Valley Hospital, then chief operating officer at Desert Springs for another five years. He served as CEO of Desert Springs for 11 years, and CEO of Desert Springs and Valley hospitals combined for about two years.

“I have lived in the Henderson community for 25 years, and it has always been a goal and dream of mine to be the CEO of a Henderson UHS-owned hospital,” Kaufman said. “Not because it’s close, but it’s where I live and have a lot of pride living in this community.”