Physician Orientation - Yuma Regional Medical Center


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Electronic Physician Orientation - Part 1 of a two part orientation for new members of the Medical Staff of Yuma Regional Medical Center

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Physician Orientation - Yuma Regional Medical Center

  1. 1. Welcome to the Medical Staff of Yuma Regional Medical Center <ul><li>  . </li></ul><ul><li>. </li></ul>YRMC is a 333-bed, CMS approved acute care hospital located in the city of Yuma, county seat of Yuma County, Arizona. As sole provider to 186,052 year-around residents (2007 stats) and an estimated 90,000 annual “winter visitors”, YRMC provides a broad range of medical care and specialties. A 2007 designation as a Health Professional Shortage Area (HPSA) provides additional benefit to the members of the local professional medical community. Main Campus – 2400 South Avenue A 928.336.2000 02/2009
  2. 2. Administration Greg Beckman President & Chief Executive Officer Stewart Hamilton, MD Vice President Medical Affairs & Chief Medical Officer (CMO) Karen Jensen, MN Vice President Patient Care Services & Chief Nursing Officer (CNO) Pat Walz, CPA Chief Financial Officer Jim Hall, FACHE Vice President Professional & Support Services Mark Parston Vice President Planning & Business Development Sharon Gardner, SPHR Vice President Human Resources Gene Shaw, FACHE, FCHIME Vice President Information Technology & Chief Information Officer (CIO)
  3. 3. Board of Directors John Hudson, Major General Retired, Chair, Board of Directors YRMC sits on land owned by the Yuma County Hospital District #1. The district is governed by a five-member board elected at-large by popular vote. The district leases the land to the YRMC corporation. In exchange, YRMC must provide community benefits and hospital services. The support of the district also allows YRMC to issue tax-exempt revenue bonds for construction. Board Members: Doug Mellon, Vice Chair; Tom Thompson, Secretary; Ronald Brooksher, M.D.; Rick Dinsmore; Pamela Walsma, Esq.; and Serena A. Holthaus. YRMC is a not-for-profit corporation governed by a 12-member volunteer Board of Directors. The board is made up of unpaid community residents who have an interest in healthcare and a strong commitment to improving the health and well-being of their fellow citizens. These directors set policy for the hospital, provide direction for long-range strategic planning and monitor financial viability. Board Members: , Joann Linville, EdD, Vice Chair; Victor Smith, Secretary/Treasurer; Kathy Watson, EdD, (Chair Elect to replace Past Chair), Jeff Andrews (mentoring term begins 01/09); Russ Clark; Larry Deason; Roberto Garcia, M.D.; Louie Hirth; Mario Jauregui; Woody Martin; Sridhar Rajamani, MD; Phillip Richemont, MD; Tom Tyree; Ian Watkinson, PhD. Lynn O’Connor, Chair Hospital District Board Hospital District Board Governance
  4. 4. Medical Staff Officers and Chairs Kamal Ahmed, M.D. Chief of Staff Open Position Officer of Staff Relations Ismael Guerrero, M.D. Vice Chief of Staff Raul Castillo, M.D. Anesthesia Phillip Richemont, M.D. Emergency Medicine Roberto Garcia, M.D. Family Medicine Tsehaye Seare, M.D. Internal Medicine Emilia Matos, M.D. Pediatrics Not shown: Victor Alvarez, M.D., Pathology ; John James, D.O. & David Plone, D.O., Radiology John Brock Amon, M.D. OB/Gyn 2009 James Moon, M.D. Surgery
  5. 5. <ul><li>237 Medical/Surgical beds </li></ul><ul><li>42 Critical Care beds </li></ul><ul><li>34 Maternity beds </li></ul><ul><li>20 NICU beds </li></ul><ul><li>20 Pediatric beds </li></ul><ul><li>15,000 In-Patients cared for annually </li></ul><ul><li>60,000 Emergency patients annually </li></ul><ul><li>10,000 Surgical procedures annually </li></ul><ul><li>3,500 Births annually </li></ul><ul><li>2,000 Employees </li></ul><ul><li>330 + Physicians; 95% Board Certified/Board Admissible </li></ul>
  6. 6. Satellite Facilities <ul><li>Yuma Regional Corporate Center </li></ul><ul><li>399 West 32 nd Street </li></ul><ul><li>Patient Accounts </li></ul><ul><li>Accounting/Payroll </li></ul><ul><li>Centralized Scheduling </li></ul><ul><li>Human Resources </li></ul><ul><li>Print Shop </li></ul><ul><li>Conference Rooms </li></ul><ul><li>United Blood Services Office </li></ul>Yuma Regional Medical Plaza 1501 West 24 th Street Outpatient Diagnostic Imaging Outpatient Surgery Center Physician & Clinic Lease Space Yuma Regional Foothills Office Foothills Diagnostic Imaging PrimeCare Urgent Care (24 hours)
  7. 7. YRMC Culture The following slides define cultural expectations of Medical Staff members at Yuma Regional Medical Center Images of Yuma - Lifestyle Enjoying one of the many golf courses in Yuma Kayaking on the Colorado River
  8. 8. YRMC Core Value <ul><ul><li>Respect for every individual </li></ul></ul><ul><ul><li>Everyone is different, everyone is necessary. YRMC is committed to developing a diverse and talented team of individuals whose differences enhance the services we provide . </li></ul></ul><ul><ul><li>It is the policy of this facility, and an expectation within the Medical Staff Bylaws, that medical staff members will treat all individuals within the facilities with courtesy, respect, and dignity. It is required that all individuals, employees, physicians and other independent practitioners conduct themselves in an ethical, professional and cooperative manner in the hospital. </li></ul></ul><ul><ul><li>Refrain from behavior that generates complaints from fellow members of the medical staff, YRMC staff, patients and their families, including but not limited to the following: </li></ul></ul><ul><ul><li>Impulsive, disruptive, harassing or inappropriate behavior with fellow members of the medical staff, YRMC staff, patients and their families. </li></ul></ul><ul><ul><li>Refrain from including documentation in the medical record that does not directly relate to the clinical status of the patient and plan of care, or that is derogatory or inflammatory concerning the care provided to the patient. </li></ul></ul><ul><ul><li>  When disagreements occur, the issues will be addressed openly, respectfully, and directly with the individual(s) with whom the disagreement occurs.  </li></ul></ul><ul><ul><li>If a disagreement is not resolved with the individual with whom the disagreement occurs, address the disagreement with that physician’s department chairperson or the YRMC staff member’s supervisor. </li></ul></ul>C O U R T E S Y R E S P E C T D I G N I T y
  9. 9. Quality Communications <ul><li>Urgent Consults : </li></ul><ul><li>Require immediate physician-to-physician contact </li></ul><ul><li>Document orders in patient records </li></ul><ul><li>Non-Urgent Consults : </li></ul><ul><li>Require timely verbal communications with the consultant </li></ul><ul><li>Document orders in patient records </li></ul><ul><li>Provide adequate written communications from the consulting physician </li></ul><ul><li>Consultation requests should be responded to within 24 hours or sooner if clinically appropriate. A response should be written (or dictated). Verbal communication with the requesting physician is required for urgent consultations and/or when clinically appropriate. </li></ul>
  10. 10. Regulatory The following slides define requirements and responsibilities of all members of the Medical Staff of Yuma Regional Medical Center Images of Yuma - Education Arizona Western College & Northern Arizona University / Yuma campus Gila Ridge High School Yuma Catholic High School
  11. 11. Medical Record <ul><li>The Medical Record </li></ul><ul><li>  </li></ul><ul><li>Is the means by which a level of communication is achieved among all healthcare providers involved in the patient's care. </li></ul><ul><li>Serves as the basis for financial reimbursement to hospitals, health care providers & patients. </li></ul><ul><li>Serves as a legal document for use by an injured patient against other parties </li></ul><ul><li>Serves as the legal document for the defense of malpractice claims and lawsuits. </li></ul>
  12. 12. Medical Record <ul><li>Proper Documentation: A Patient's Record </li></ul><ul><li>Should be clearly labeled with patient's complete name and medical record numbers . </li></ul><ul><li>All examinations of patients should be documented in the record. </li></ul><ul><li>Entries should state the Month , Day , Year , and Time of day, and the Signature of the provider making the entries. </li></ul><ul><li>Entries should be made using only hospital accepted terminology and abbreviations (The Department of Health Records maintains information on approved abbreviations). </li></ul><ul><li>Associated records and tests ( e.g. EKG's, EEG's, Fetal Monitoring tracings, etc .), should all be properly labeled with patient's name , medical record number and when appropriate, Date and Time performed. </li></ul><ul><li>Progress notes should indicate that the patient was kept informed of his/her condition, as well as the treatment plan. </li></ul><ul><li>Entries should document all instances of patient non-compliance or refusal of recommended treatment; and that the patient was informed of potential consequences of non compliance. </li></ul>
  13. 13. Medical Record <ul><li>Entries should only be made via electronic medical record or on approved hospital medical record forms </li></ul><ul><li>Entries should only be made using a pen, never a pencil or felt-tipped marker. </li></ul><ul><li>Providers must never alter a patient record. One should not erase, obliterate or attempt to edit notes previously written. </li></ul><ul><li>To indicate a correction, draw a single line through any erroneous hand written chart entry and write &quot;error&quot; with the date, time, and your initials. Hospital approved electronic correction must be used. </li></ul><ul><li>All corrections, late entries, entries made out of time sequence, and addenda should be clearly marked as such in the record.  Include date, time of day written, and signature. </li></ul><ul><ul><li>The Medical Record is used by hospital quality assurance and peer review committees, State licensing & regulator agencies, and other entities in assessing the quality of patient care by hospitals and health care providers; </li></ul></ul><ul><ul><li>In addition, the Medical Record Is a key portion of hospital accreditation processes, and can be used in clinical research (via retrospective and/or concurrent review) </li></ul></ul>
  14. 14. Yuma Regional Medical Center is committed to providing patients the best and safest care possible. Processes are in place to report, evaluate and take actions to address safety concerns of staff, members of the Medical Staff, patients, and family members. Quality Services & Patient Safety provides oversight for all processes related to Quality of Care, Patient/Staff/Visitor Safety and Infection Prevention. This team also coordinates the organization’s collection and aggregation of patient care data for quality improvement and regulatory reporting. YRMC strongly believes that efforts to improve quality of care must focus on process rather than individuals and promotes a “Just Culture” philosophy when managing “near misses” or actual patient harm. Quality Services & Patient Safety
  15. 15. Quality Services & Patient Safety 1. YRMC has developed numerous protocols and clinical pathways for the care of patients diagnosed with AMI, CHF, pneumonia as well as the SCIP project (Surgical Care Improvement Project) to help reduce variation and ensure that core care process are completed and documented. The use of these evidence-based pathways and protocols will help clinicians focus on other aspects of patient care. 2. Physician/Specialty level data is collected through MIDAS and is available to physicians to help review practice patterns and improve patient care processes. Please contact Quality Services at 336-7315 to discuss what data is available to you. 3. YRMC utilizes PRC (Professional Research Consultants) to conduct patient satisfaction surveys. These surveys include questions regarding physician interaction with the patient and others. 4. If you have any suggestions regarding improving patient care process please provide your name to the Director of Quality and Patient Safety at 336-7315 or the Vice President of Medical Affairs, Chief Medical Officer.
  16. 16. Report any safety concerns by calling Quality Services at 336-7586. Your concerns will be forwarded to the appropriate individual for action. Report all “near-misses” via Remote Data Entry on the YRMC Intranet (see the following slides). Near-misses are indicative of a larger process problem. Safety <ul><li>Your role in an EMERGENCY: care for your patients. YRMC nursing staff and others will direct actions necessary when an event occurs which may require other actions . </li></ul><ul><li>FIRE: Pull the nearest fire alarm station (usually at an exit point such as stairwell or other exit). </li></ul><ul><li>If a CODE RED (Fire) is paged overhead: </li></ul><ul><li>Remain where you are (if safe to do so). </li></ul><ul><li>Follow the instructions of the staff until the Code Red is cleared. </li></ul>With patient safety in mind, YRMC has developed the following protocols:
  17. 17. Reporting of Incidents What is a Reportable Incident? An incident is defined as any happening not consistent with the routine operation of the facility or routine care of a particular patient. Incidents include “near misses” and must be reported to Risk Management. Examples of reportable events include but are not limited to: Patient Injury; Pressure ulcers; Fall – patient or visitor; Behavioral actions/attitudes; Medication issues; Patient Identification errors   When Do I Report an Incident? Once the patient care situation is stabilized, the individual who discovers, witnesses or is notified of the incident should immediately complete the incident report. Serious incidents require immediate verbal notification of the Risk Manager or Risk Coordinator. How Do I Report an Incident? There are two options: 1. Electronic: using remote data entry via the YRMC Intranet. 2. Verbal: contact the Risk Manager or Risk Coordinator. Use the name of the patient involved and document in the patient chart. NOTE: visitor injuries are tracked as non-patient entries. Why Report? Reporting incidents may result in changes in policies, procedures and processes to protect patients, visitors and staff from similar occurrences. The gathering of incident data enables YRMC to define trends, develop preventative actions and addresses educational needs. Risk Management
  18. 18. Risk Management <ul><li>Emergency Guidelines for Event Management </li></ul><ul><li>Patient care is the top priority and should not be delayed. Continue to treat the patient with dignity and respect. </li></ul><ul><li>Do NOT avoid contact with the patient or family. Be tactfully open and honest regarding the situation. Should the situation warrant, say “I’m sorry that you had this experience”. </li></ul><ul><li>Document the incident; notify the department Supervisor; create an Incident Report (using MIDAS and Remote Data Entry via the YRMC Intranet). </li></ul><ul><li>Sequester any and all evidence </li></ul><ul><li>  Identify all witnesses. All written and verbal communication about the event is limited to Risk Director, Risk Management Coordinator, or defense counsel. </li></ul><ul><li>Refer all billing questions to the Risk Director or Risk Management Coordinator. Do NOT make promises regarding billing concerns or payment ‘write off’. </li></ul><ul><li>  Consult with the Risk Director or Risk Management Coordinator regarding all post incident verbal and written communications. </li></ul>
  19. 19. Security <ul><li>Designated Parking - Medical Staff members may park in any designated parking space, (reserving handicapped spaces for use as appropriate). Covered parking spaces are available for members of the Medical Staff on a first-served basis. Use Identification Badges to gain entry. </li></ul><ul><li>Security escorts are available to your vehicle by calling Security at 336-2400. </li></ul><ul><li>Report any security concerns or suspicious activities to 336-2400. </li></ul>For the safety of patients and staff, as well as professional courtesy, Medical Staff members are expected to wear their Identification Card when in the facility. Your picture ID provides access pass to various areas of the facility. All physicians have default access to all building entry points, physician lounges, and physician covered parking. If you need additional access or experience problems with your badge, please contact Physician Relations at 336-7526. Security is available 24 hours a day at 336-2400 (hint: 2400 is the street address of the facility)
  20. 20. Peer Review <ul><li>  </li></ul>A patient care episode may be selected for peer review at any time . Examples include: Re-admission within 30 days; Unplanned admission to the ICU, Returns to Surgery; Patient complaints; Incidents reported through Risk Management. All potential peer review cases may go through one or more of the following processes: 1. Registered Nurse Review 2. Physician Review 3. Quality Monitoring Committee Review 4. MEC & Board Review For more detail on the Peer Review process at YRMC, please contact Peer Review at 336-1640
  21. 21. HIPAA & PHI The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires health care providers protect patient’s health information. Patient information protected by HIPAA is called Protected Health Information or PHI. HIPAA requires that PHI be protected, regardless of its form —verbal/oral, electronic, paper. <ul><li>What qualifies as PHI ? </li></ul><ul><li>Information created or received by a health care provider, health plan, or health care clearinghouse. PHI includes some of the following: patient name, address, social security number, telephone, email, health plan information, medical record, and health condition information . </li></ul><ul><li>Information which relates to payment for health care or the physical or mental health condition of an individual. </li></ul><ul><li>Information which identifies an individual. </li></ul>PHI is protected by following these guidelines: * Keep computer passwords private * Log off computers when not present * Position computer screens so they are not visible to others * Don’t discuss patients in areas where you may be overheard * Use care when discussing PHI over the phone * Lock or secure areas where PHI is located * Don’t leave PHI documents unattended in non secure areas * Discard PHI documents in bins designated as “Confidential”
  22. 22. HIPAA & PHI <ul><li>Email Encryption : Encryption, also known as encoding, takes text, data or other communications and encodes it. An encrypted file will appear as gibberish unless the message recipient has the electronic password or key necessary to decrypt (translate) the information. </li></ul>For Information about how to decrypt email messages containing PHI, contact Information Services at 336-7290 or register online at YRMC strives to protect PHI through use of: <ul><li>Password Protection: Members of the Medical Staff are issued individual access to PHI and are asked to maintain the confidentiality of their unique passwords. </li></ul>
  23. 23. Corporate Compliance Corporate compliance ensures quality patient care occurs in a manner which fully complies with all applicable state and federal laws and regulations. YRMC’s Code of Conduct and Corporate Compliance Plan applies to relationships with patients, physicians, volunteers, board members, payers, suppliers, the community we serve and to each other. <ul><li>The key elements of Corporate Compliance: </li></ul><ul><li>Prevent, identify, and correct unlawful and unethical behavior at an early stage. </li></ul><ul><li>Demonstrate our commitment to honest and responsible corporate conduct. </li></ul><ul><li>Use internal auditing and monitoring to minimize the exposures associated with improper activity and ensure we comply with the False Claims Act. </li></ul><ul><li>Encourage open lines of communications without fear of retaliation . </li></ul><ul><li>YRMC maintains an anonymous “Compliance Hotline”. Call 336-7457 to voice concerns or complaints. </li></ul>Harsh legal penalties may be applied if, through the act of fraud or abuse, YRMC fails to comply with certain government rules. Penalties may include monetary settlements, exclusion from federally funded programs (Medicare & AHCCCS), and the possibility of criminal prosecution and incarceration.
  24. 24. EMTALA <ul><ul><li>Under the Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986, any individual who &quot;comes to the emergency department&quot; seeking treatment for a medical condition must receive an appropriate screening examination and treatment/stabilization of emergency medical conditions. </li></ul></ul>If the screening examination reveals that the individual has an emergency medical condition, including when the individual is in labor, the hospital must either provide for further examination and treatment of the individual in order to stabilize the emergency condition or it must make an appropriate transfer of the individual to another facility .
  25. 25. Yuma Regional Medical Center’s Patient Advocate researches patient concerns and/or complaints involving a patients’ hospital experience. Following Conditions of Participation Guidelines established by the Centers for Medicare Services, the Patient Advocate acts as a liaison as needed between staff, physicians, and patients when a complaint is noted. Unresolved complaints regarding physicians are forwarded to the Quality Services Department and are addressed according to YRMC Medical Staff Policy and Procedures. Patient Complaints Contact Numbers: 336-7002 or 336-3672
  26. 26. Patient Processes The following processes are designed to assist clinicians in providing efficient and effective care to patients of Yuma Regional Medical Center Images of Yuma – Health Care YRMC - Wound Care Center YRMC – Intensive Care Unit YRMC – Pharmacy Robot
  27. 27. Effective Hand Hygiene: There is no substitute! Yuma Regional Medical Center expectation is 100% compliance with proper hand hygiene protocols to reduce the incidence of Hospital Acquired Infections (HAI*). The single most important means of preventing the spread of nosocomial infection, including Multi-Drug Resistant Organisms (MDRO) is a personal commitment to effective hand washing. Hand Washing Protocol: Wash hands with warm, running water; add soap and lather well; rub hands vigorously (creating friction) for 15-20 seconds; scrub all surfaces – back of hands, in between fingers, wrists. Rinse hands and dry with a disposable towel. Use the towel to turn off the faucet. * HAI: infection acquired by patients while in the hospital, unrelated to the condition for which the patient was hospitalized
  28. 28. <ul><li>SOAP & WATER: </li></ul><ul><li>Wash hands with soap (antimicrobial or non-antimicrobial) and water when hands are visibly soiled and in the following situations: </li></ul><ul><li>Before having direct contact with patients </li></ul><ul><li>Before donning sterile gloves to insert a central intravascular catheter. </li></ul><ul><li>Before inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive devices that do not require a surgical procedure. </li></ul><ul><li>After contact with a patient's intact skin (e.g., when taking a pulse or blood pressure). </li></ul><ul><li>After contact with body fluids or excretions, mucous membranes, non-intact skin, and wound dressings, if hands are not visibly soiled. </li></ul><ul><li>When moving from a contaminated-body site to a clean-body site during patient care. </li></ul><ul><li>After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient. </li></ul><ul><li>After removing gloves. </li></ul><ul><li>Before eating and after using the restroom. </li></ul>ALCOHOL BASED HAND RUB: An alcohol-based hand rub can be used if hands are not visibly soiled and as an alternative to using soap & water when that option is not available. Alcohol solutions containing 60% to 95% alcohol are most effective. The recommended technique for using an alcohol-based hand rub is to apply the product generously to one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry (at least 30 seconds). Follow the manufacturer's instructions regarding the amount of product to use. Centers for Disease Control & Prevention Hand Washing Recommendations: Infection Control
  29. 29. Patient Admissions (All) YRMC has adopted the SBAR (Situation, Background, Assessment, Recommendation) format for handing-off patients. SBAR ensures all pertinent information is shared. S – Situation Admitting & Secondary Diagnosis; Current Issues B – Background Pertinent Medical History; Physician & Ancillary Staff Consults Previous Tests & Treatments; Psychosocial Issues Allergies, Current Code Status A – Assessment Head-to-Toe Physical Assessment; Vital Signs IV’s, Drips, Line Site Assessment; Oxygen, Vent Settings Pain Status; Drains, Tubes, Wound Assessment & Care ADL’s, Diet, Activity; Restrictions; Isolation, Fall, Bleeding Precautions, Fluid; Labs, Diagnostics Response to Treatments Care Partner, Family Updates R – Recommendation Plan of Care; Needs to be Addressed Orders Pending Completion; Pending Treatment and Tests Discharge Planning, Issues, Barriers
  30. 30. Patient Admissions Information requested for ADMISSION : (please have the following information available) * Patient Name * Date of Birth * Medical Record Number (if known) * Diagnosis * Admitting Physician Name * Special Needs (e.g. Telemetry) * Type of Admission (e.g. Full admission or up to 48 hour observation) Medically Unstable Patients: - For patients requiring immediate medical intervention - Please send this patient to the Emergency Department Medically Stable Patients: Please keep the patient in your office until the House Supervisor or Resource Coordinator calls you back with a room number. Please keep in mind that during periods of heightened patient care, this process may take a bit longer. When the hospital is full, the House Supervisor/Resource Coordinator may request that the patient be allowed to wait in the comfort of his/her own home until a bed is available. If agreeable, please provide a home telephone number to the House Supervisors/Resource Coordinator. Please do not send patients to wait for beds in the Hospital’s main entrance. There are no trained healthcare personnel to monitor, assess, or access a patient.
  31. 31. Maternity Admissions For all MATERNITY admissions from the Physician Offices, please call Labor & Delivery Resource Coordinator at 336-3760 Adult Admissions For all ADULT admissions from the Physician Offices, please call House Supervisor at 336-3787 There are five (5) House Supervisors who provide coverage 24 hours a day, 7 days per week. The House Supervisor’s goal is to make the admission process smooth for the patient, and to place the patient in the most appropriate unit. Pediatric Admissions For all PEDIATRIC admissions from the Physician Offices, please call Pediatric Resource Coordinator at 336-3750 If the line is busy, call 336-7878 or House Supervisor at 336-3787
  32. 32. Patient Care Departments The following departments provide services to patients at Yuma Regional Medical Center Images of Yuma - Housing The Terraces The Dunes Winsor Park
  33. 33. Emergency Department <ul><li>Main ED- Acuity Level 1,2,3 Staff: At least one board certified ED physician on duty at all times </li></ul><ul><li>ED North-Acuity Level 3,4 Staff: ED Family Practice physician or FNP/PA </li></ul><ul><li>ED South-Acuity Level 4,5 Staff: FNP/PA </li></ul><ul><li>Stabilize and transfer neurological head/spinal injury, major burn, pediatric intensive care, and psychiatric patients </li></ul><ul><li>Nurses ACLS/PALS certified; most TNCC certified </li></ul><ul><li>24/7 coverage </li></ul><ul><li>37 beds </li></ul><ul><li>60,000 visits per year </li></ul>
  34. 34. House Supervisors <ul><li>Five (5) House Supervisors provide coverage 24 hours a day, every day. </li></ul><ul><li>The House Supervisor’s main function is to manage the patient throughput & placement from either a direct admission or admission through the Emergency Department. </li></ul><ul><li>In addition to patient placement, House Supervisors are a 24-hour resource to the Medical Staff for </li></ul><ul><li>Clinical back up for nursing </li></ul><ul><li>Code Team </li></ul><ul><li>Rapid response team members </li></ul><ul><li>Knowledge of hospital policies & procedures </li></ul><ul><li>Representation for Administration outside of normal office hours </li></ul><ul><li>After-hours Media contacts and Public Relations </li></ul><ul><li>General information </li></ul><ul><li>Trouble shooting </li></ul><ul><li>House Supervisors maintain the physician on-call lists for the Operating Rooms, Endoscopy, Bronchoscopy, and other clinical areas. </li></ul><ul><li>House Supervisor 24 hour access: 336-3787 </li></ul>
  35. 35. Case Management <ul><li>Yuma Regional Medical Center’s Department of Care Coordination Services is staffed with Nurses and Master’s level Social Workers to: </li></ul><ul><li>Expedite acute care transfers. </li></ul><ul><li>Facilitate discharges to home, arrange for durable medical equipment (DME), skilled nursing facility (SNF), Yuma Rehabilitation Hospital, a higher level of care, or return the patient to his own health care system. </li></ul><ul><li>  Complete utilization review and communicate with payer sources. </li></ul><ul><li>  Provide for support for patient areas and can be contacted via the Resource Nurse or B.A. </li></ul><ul><li>  Network with international, national, state, county and local resources. </li></ul><ul><li>  Liaison between the behavior health resources and YRMC for patients with psychiatric needs. </li></ul><ul><li>  Collaborates closely with the Hospitalist physicians. </li></ul><ul><li>  Works closely with Adult Protective Services, Child Protective Services and other regulatory agencies. </li></ul><ul><li>  Works closely with Palliative Care, Hospice, dialysis, and other specialty services. </li></ul><ul><li>  Provide information to assist families with financial concerns. </li></ul>
  36. 36. Inpatient Wound Care <ul><li>YRMC provides inpatient wound care assessment and treatment through Wound, Ostomy & Continence Nursing staff (WOCN). </li></ul><ul><li>A complete skin assessment should be performed on all patients admitted. Per CMS guidelines, pressure ulcers which are present on admission (POA*) must be documented by the Primary Care Physician or LIP. </li></ul><ul><li>Documentation may occur in the admission note, the History & Physical (H&P), or in the Progress Notes. A Photographic Wound Documentation form has a section for the physician’s wound documentation and can be placed in the Progress Notes section of the patient record. </li></ul><ul><li>(MIST) therapy system is available for bedside debridement of unstageable pressure ulcers. MIST is a low frequency, non-thermal ultrasound device which allows for more rapid debridement and promotes healing. To order MIST therapy (process? Call?) </li></ul><ul><li>* Medical record documentation from any provider involved in the care and treatment of the patient may be used to support the determination of whether a condition was present on admission or not. The term “provider” means a physician or any qualified healthcare practitioner who is legally accountable for establishing the patient’s diagnosis. </li></ul>
  37. 37. Diagnostic Imaging Services Digital images available through PACS & Physician Portal 24 hours a day <ul><li>Digital and Computed Radiography </li></ul><ul><li>Portable Radiography </li></ul><ul><li>Fluoroscopy, Mobile C-Arms </li></ul><ul><li>Bone Mineral Density </li></ul><ul><li>Five CT Scanners (16 & 32 slice scanners available) </li></ul><ul><li>Mammography (available at three sites in the Yuma area)* </li></ul><ul><li>MRI* Open 0.3 Tesla; 1.5 Tesla standard bore, 1.5 Tesla Short Bore </li></ul><ul><li>Nuclear Gamma Cameras; two dual head cameras, one single head camera, and thyroid uptake probe. </li></ul><ul><li>PET/CT </li></ul><ul><li>Digital, Flat-Panel Special Procedures Laboratory </li></ul><ul><li>Ultrasound* </li></ul><ul><li>Imaging available at four sites; YRMC, YRMC Outpatient Imaging Center, Foothills Imaging Center, and Mammography services at Women's Health Specialists. </li></ul><ul><li>*Modalities Accredited by the American College of Radiology </li></ul>
  38. 38. Laboratory <ul><li>The Laboratory at YRMC is divided into separate sections:  </li></ul><ul><li>Clinical Chemistry concentrates on tests done on the fluid portion of blood, as well as some other bodily fluids. </li></ul><ul><li>Hematology looks at the cellular components of blood and coagulation involved in clotting. </li></ul><ul><li>Microbiology deals with infectious diseases, which can include diseases caused by bacteria, viruses, fungi, parasites, or tuberculosis. </li></ul><ul><li>The Blood Bank deals with transfusions. </li></ul><ul><li>Phlebotomy collects blood specimens for testing. </li></ul><ul><li>Histology and Cytology deal with anatomic pathology.   </li></ul><ul><li>Laboratory & Pathology staff are readily available to advise treating physicians and others on which tests to order and discuss the implications of test results.   </li></ul><ul><li>In operation 7 days a week, 24 hours a day, laboratory technicians run stat specimens, supervise the Blood Bank, and support the lab needs of the facility.   </li></ul>Results:  Turnaround time varies by test from a few hours to several days for particularly complex tests. Test results can be delivered by phone, fax, written report or computer reporting.  
  39. 39. Laboratory YRMC Blood Bank United Blood Services supplies 100% of the blood used at Yuma Regional Medical Center
  40. 40. Pharmacy <ul><li>The Pharmacy at YRMC operates to meet the pharmaceutical care needs of patients and contribute to achieving the objectives of this Medical Center by: </li></ul><ul><li>assuring appropriate patient specific pharmacotherapy, </li></ul><ul><li>establishing effective drug use and control, </li></ul><ul><li>providing education related to pharmaceutical care, </li></ul><ul><li>disseminating valuable and accurate drug information </li></ul><ul><li>Acting as a resource on the patient floors for immediate feedback and support to physicians and staff </li></ul><ul><li>The Inpatient Pharmacy at YRMC operates 24 hours per day, 7 days a week to support the needs of the patients in the care of this facility. </li></ul><ul><li>Pharmacists stationed on patient floors provide assistance and support in meeting the pharmacotherapy needs of our patients. </li></ul><ul><li>Supported by leading edge technology, the YRMC pharmacy staff strive to ensure accurate dosing, eliminate medication dispensing errors, review of drug interaction effects, and availability of medication at the time needed. </li></ul>Elvis: Electronic Medication Dispenser located in the Main YRMC Pharmacy
  41. 41. Health Records Transcription & Clerical Support Services: Available 24 hours per day, seven days per week. (336 prefix): 7215; 2284; 2285. Pager for clerical support services is 376-4196. Clinical Documentation Team: Available on the floors to query for specific diagnoses documentation. Deficiency Analysis : Records are required to be completed within 30 days past patient discharge. Chartmaxx Support: Contact the Help Desk at 336-7290. For Patients: Records are available to patients with proper ID in two locations: The Heart Center Lobby or Main Lobby For Physicians: Health Records is located in the southern end of the ground floor at the base of Tower A, next to Physician Relations office.
  42. 42. Heart Center <ul><li>Non Invasive Services: </li></ul><ul><li>Cardio-Defibrillator Checks </li></ul><ul><li>Tilt Table </li></ul><ul><li>Cardioversion Procedure </li></ul><ul><li>Invasive Services: </li></ul><ul><li>Diagnostic Cardiac Catheterizations </li></ul><ul><li>Cardiac Interventions </li></ul><ul><li>Diagnostic Peripheral-Vascular Catheterizations </li></ul><ul><li>Peripheral-Vascular Catheterizations </li></ul><ul><li>Balloon Angioplasty </li></ul><ul><li>Stent placement </li></ul><ul><li>Pacemaker & Cardio-Defibrillator Implantation </li></ul><ul><li>Diagnostic Catheterizations and </li></ul><ul><li>Interventions of Carotids </li></ul><ul><li>64 Slice CT Scanner </li></ul><ul><li>To schedule: 726-5757 </li></ul><ul><li>Cardiac CT Scan/ Calcium Scoring • Full Body Scan • Lung Pulmonary Embolism Detection • CT Vascular Imaging • CT Carotid Imaging • CT Virtual Colonoscopy • Oncology Imaging • Brain Perfusion and Analysis </li></ul>
  43. 43. Inpatient Cardiac Rehabilitation education is available by requesting “ Cardiac rehab ” on the physicians order sheet in the patient chart. Please indicate the subject matter preferred. The RN level staff providing inpatient education screen patients for referral to the outpatient cardiac rehabilitation program. YRMC’s Cardiac Rehabilitation services offer medically supervised and individualized outpatient exercise programs for people who have had a heart attack, heart surgery, angina, stent placement, angioplasty, or other heart problems. Our cardiac rehab health professionals assist each patient in setting goals and monitoring progress on a daily basis. A cardiac rehab nurse specialist and an exercise physiologist work with each patient and closely monitor electrocardiogram tracings and blood pressures during exercise sessions. Risk factor and lifestyle modifications are important to successful cardiac rehabilitation. Health education classes are available. A physician referral is required for services covered by Medicare and insurance companies. To make a referral, call 336-1015, or FAX 726-5476 Cardiac Rehab
  44. 44. Wound Care Center Any patient with a wound that is not healing may be a candidate for advanced wound care. Program staff specialize in the outpatient treatment of problem, non-healing wounds. Some of the conditions appropriate for wound therapy are:          * Pressure ulcers  *Diabetic ulcers *Neuropathic ulcers *Ischemic ulcers *Venous insufficiency  *Traumatic wounds *Surgical wounds *Vasculitis *Peristomal skin irritations *Other chronic, non-healing wounds and complications of radiation therapy, eg radiation cystitis,proctitis, etc.. Yuma Regional Wound Care Center has hyberbaric oxygen therapy used to treat conditions such as: Gas gangrene; Acute traumatic peripheral ischemia ; Acute peripheral arterial insufficiency; Preparation and preservation of compromised skin (not for primary management of wounds). <ul><li>The Wound Care Center programs utilize the newest clinical tools in wound healing along with traditional clinical practices including: </li></ul><ul><li>Debridement </li></ul><ul><li>Advanced wound dressing </li></ul><ul><li>Compression therapy </li></ul><ul><li>Hyperbaric oxygen therapy </li></ul><ul><li>Prescriptive growth factors </li></ul><ul><li>Bio-engineered skin grafting </li></ul><ul><li>Edema management </li></ul><ul><li>Non-invasive vascular assessment </li></ul><ul><li>For Referrals, Contact 336-2030 </li></ul>
  45. 45. Supportive Services The following departments provide support services for members of our Medical Staff Images of Yuma - Landscapes Breathtaking Sunsets Agriculture - Yuma’s #1 Industry Water Sports on the Colorado River
  46. 46. Designated Interpreters <ul><ul><ul><li>To assist Designated Interpreters provide quality service: </li></ul></ul></ul><ul><ul><ul><li>Prior to interpretation session, please brief Designated Interpreter (best practice) </li></ul></ul></ul><ul><ul><ul><li>Speak in short phrases to allow time for interpretation </li></ul></ul></ul><ul><ul><ul><li>Allow Designated Interpreters a short pre-session ( roughly 10 seconds; see below ) </li></ul></ul></ul><ul><ul><ul><li>Interpreters will not sanitize language; they will say everything word for word </li></ul></ul></ul><ul><ul><ul><li>Understand interpreting is a secondary role for interpreters; they will need to return to their areas as soon as possible </li></ul></ul></ul><ul><ul><ul><li>Designated Interpreters Role: </li></ul></ul></ul><ul><ul><ul><li>Speak in the “first person” </li></ul></ul></ul><ul><ul><ul><li>Conduct a pre-session briefing stating that “anything said will be repeated and confidential” (to both provider and patient) </li></ul></ul></ul><ul><ul><ul><li>Will be positioned next to provider </li></ul></ul></ul><ul><ul><ul><li>Have the right to pause dialogue and use a medical dictionary or consult a fellow interpreter for proper verbiage </li></ul></ul></ul>YRMC provides trained bilingual staff for Spanish language interpretation in the clinical setting. “Designated Interpreters” are hospital staff who have completed specialized clinical training and provide interpreter services in addition to regularly assigned duties In addition to YRMC Designated Interpreters, the Cyracom system is available 24 hours a day in 150 languages (dual headset telephonic interpretation). <ul><ul><li>Risks associated with using non designated interpreters (such as family members) includes: Breaches of confidentiality; Distortion of message; Danger (e.g., abusive spouses who interpret); Lack of impartiality; Trauma/missed school/abuse/confusion for children who interpret for family; Loss of benefits and rights; Injury, malpractice, re-victimization, lawsuits, death </li></ul></ul>
  47. 47. YRMC Department Information Systems – Help Desk Help Desk 24 hour technical service YRMC’s Information Services Department operates a 24 hour Help Desk for assistance with computer software applications and service to facility-owned hardware components. Help Desk Operators will strive to address technology concerns at the point of contact. If the issue requires more specific technical intervention, the Help Desk will initiate a service call to address the issue. Call 336-7290 Email: [email_address] Here for you, 24 hours per day, 7 days a week
  48. 48. Spiritual Care 24 hour supportive service The Department of Spiritual Care and Patient Advocacy supports a full-time chaplaincy service to address the spiritual dimension of health. Chaplains are available 24 hours a day, 7 days per week and are often called to assist families and staff who are in crisis, experiencing trauma and/or during various phases of illness and recovery.  Chaplains are always available to support patients, families and staff through end-of-life circumstances.  The chaplaincy service is non-denominational, but works closely with local community clergy to meet the special religious and sacramental needs of patients and their families. In collaboration with Yuma Regional Medical Center, the Department of Spiritual Care and Patient Advocacy offers an accredited Clinical Pastoral Education Program (CPE) to prepare master’s level ministers to serve in the unique environment of a healthcare setting.  Referrals to the chaplaincy service are made through the admission process, by the physician or by a nurse.  Patients may also self-refer to this supportive service. To reach the ‘on-call’ chaplain at any time, call 336-3673. 
  49. 49. Medical Library The John F. Stanley Memorial Medical Library provides access to health care information to the Medical Staff, YRMC employees, health care providers in the community, and members of the public. The Library is staffed Monday through Friday, from 8:30 a.m. to 5:00 p.m. The Medical Librarian can provide research services and obtain copies of articles from other libraries. Members of the Medical Staff may access the library after business hours/weekends by use of their ID badges/proximity access reader outside the door of the library. The Medical Library contains books and journals in the health sciences. Many books may be checked out for a two-week period. If the book has not been requested the loan period may be extended. Recommendations for additions to the collection are always welcome. In addition to the print collection, users have access to a growing number of electronic resources, via YRMC’s membership in the Arizona Health Information Network. Two Internet access computers are available. The library subscribes to the local newspaper and the Wall Street Journal . To register for remote access to the Medical Library’s electronic resources (through Athens) go to: . For more information about the Medical Library’s resources and services, call 336-7181 or e-mail [email_address] .
  50. 50. Medical Staff Services The Medical Staff Services processes applications for Medical Staff privileges at Yuma Regional Medical Center and coordinates background checks of practitioners. In addition, staff also: Provide notices of renewals (as applicable) for - Arizona State Licensure, - DEA, - Certification, - TB Attestation and - Professional Liability Insurance. Coordinate Department & Medical Staff Governance meetings e.g. Credentials Committee; Quality Monitoring Committee and Medical Executive Committee . Maintains medical staff roster of up-to-date names, addresses, telephone, fax, email, ( please forward changes as they occur to MSS ) Coordination of all CME programs
  51. 51. <ul><li>Provisional Status </li></ul><ul><li>Physicians : </li></ul><ul><li>As a new member, physicians are under a one year provisional period. </li></ul><ul><li>Provisional physicians can vote at department meetings. </li></ul><ul><li>Provisional physician may not vote at general medical staff meetings. </li></ul><ul><li>Allied Health : </li></ul><ul><li>Allied Health members are welcome to attend both department meetings and medical staff meetings. Allied Health members do not have a vote. </li></ul><ul><li>Once appointed, reappointment will normally occur every two years. </li></ul><ul><li>  </li></ul><ul><li>  </li></ul>Medical Staff Services
  52. 52. <ul><li>YRMC’s Physician Relations Team, a division of the Medical Staff Services Department, provides the Physician Recruitment and Physician Liaison services for the facility. </li></ul><ul><li>Physician Recruitment ~ </li></ul><ul><li>Oversight of Medical Staff manpower needs </li></ul><ul><li>Sourcing & Identifying Candidates </li></ul><ul><li>All aspects of recruitment </li></ul><ul><li>Assisting in transitions to the community </li></ul>Physician Relations <ul><li>Physician Liaison ~ </li></ul><ul><li>Communications to Physicians/AHPs from the Administration & other YRMC Departments </li></ul><ul><li>Advocacy for physicians & AHPs </li></ul><ul><li>Monthly Newsletter “Physician News Now” </li></ul><ul><li>Maintenance of the CareLine – YRMC’s 24 hour access to a Nurse or physician referrals. </li></ul><ul><li>Updates to roster of physicians accepting new patients </li></ul><ul><li>Forms required for use by Physicians and their offices </li></ul>
  53. 53. <ul><li>YRMC’s Community Relations Team provides the Public Relations, Marketing, Corporate communications and Strategic Data Analysis processes for the facility. </li></ul><ul><li>Health Education & Outreach programs, e.g. Community health fairs, School education programs </li></ul><ul><li>Health Awareness Campaigns </li></ul><ul><li>YRMC Marketing Campaigns to promote new products, services, etc. </li></ul><ul><li>Media Communications </li></ul><ul><li>Internal Staff Communications </li></ul><ul><li>Strategic Marketing Campaigns </li></ul><ul><li>Data analysis for market planning/strategic planning </li></ul>Community Relations Health Awareness Campaigns Conceptions & Implementations by the Community Relations Staff of YRMC The Pulse: Employee Newsletter Annual Report to the Community Community Health Outreach Events
  54. 54. <ul><li>COVERED PARKING </li></ul><ul><li>Three Locations </li></ul><ul><li>Southeast (Bed Tower) </li></ul><ul><li>Northwest (Emergency Department) </li></ul><ul><li>East (Labor & Delivery) </li></ul><ul><li>LOUNGES </li></ul><ul><li>Three Locations </li></ul><ul><li>Main Lounge – Med Staff Services </li></ul><ul><li>Surgery </li></ul><ul><li>Labor & Delivery </li></ul><ul><li>Dining Service (limited availability) </li></ul><ul><li>Computer Access </li></ul>The Administration of Yuma Regional Medical Center strives to make the practice of medicine as seamless as possible. The provision of covered parking and dining amenities for physicians and allied health members is designed to allow for more efficient use of clinicians’ time. Covered parking lots and dining/lounge areas are accessible by the use of the computerized Identification Badges issued to individual clinicians at Stage II orientation. Use of these facilities is limited to members of the Medical Staff. Amenities created with our Medical Staff in mind… <ul><li>Outpatient Pharmacy Access </li></ul><ul><li>Discounted OTL Medications </li></ul><ul><li>Discounts on Prescribed Medications </li></ul>
  55. 55. We’re Not for Profit, We’re for the Communities We Serve As a not-for-profit community hospital, Yuma Regional Medical Center seeks opportunities to enhance patient care, patient education, and access to healthcare in the local communities. Images of Yuma – At Play Stewart Vincent Wolfe Playground at Yuma’s West Wetlands City Park. Built entirely by community volunteers including YRMC staff, Medical Staff & Board Members
  56. 56. The Foundation of Yuma Regional Medical Center <ul><li>Hosting fundraising activities throughout the year, the Foundation supports Yuma Regional Medical Center’s not-for-profit status, funding quality services and programs to meet the healthcare needs of the residents of Yuma County. </li></ul><ul><li>One such program is the School Based Health Care Clinics. The program is designed to meet the needs of uninsured children and parents who cannot access services due to a variety of socioeconomic barriers. Support of this program keeps simple medical problems from turning into life-threatening illnesses. </li></ul><ul><li>Under the direction of a volunteer Board of Directors, Additional projects supported by the Foundation include: </li></ul><ul><li>Healthcare Scholarships </li></ul><ul><li>Funding a mobile health clinic </li></ul><ul><li>Expansion of Heart Services </li></ul><ul><li>Palliative Care/Healing Garden </li></ul><ul><li>Diabetes Education Program </li></ul><ul><li>Neonatal ICU </li></ul><ul><li>Annual School Supply Drive </li></ul>M ission: to Support a Healthier Community School Health Care Van Healthcare Scholarships
  57. 57. Medical Staff Orientation This concludes the electronic portion of the Orientation to the Medical Staff. Please contact the Physician Relations Office to schedule Computer Training at 928-336-7526 or [email_address] prior to providing patient care. Images of Yuma - Lifestyles Yuma Art Center Kayaking on the Colorado Year around Golf
  58. 58. Main Lobby Special Procedures Room Women’s Labor & Delivery Women & Children’s Entrance Main Entrance - YRMC