GREATER NAPLES LEADERSHIPMasters Class XVIII

Healthcare Day, February 5, 2014Jim Nathan Presentation

Caring People, Caring for

People

©Copyright Lee Memorial Health System • All rights reserved

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Who We Are…

• Over 10,500 employees, 1,200 physicians and 4,300 volunteers

• $1.2B annual budget; $.6B local employment

• Fourth largest public (governmental) health system in nation

• Largest public health system in U.S. operating without benefit of local tax support

Who We Are…• One of Florida’s most significant safety

net health systems

• State-designated programs- Trauma Center (Level II) - Regional Perinatal Center (Level III)

- Children’s Oncology, Sickle Cell and Cystic Fibrosis Centers

- Kidney Transplant Center- Memory Disorders Center- Nationally designated facility for bioterrorism at Cape Coral Hospital

HealthPark Medical Center Cape Coral Hospital

Lee Memorial HospitalGulf Coast Medical Center

caring people, caring for kids

Golisano Children’s Hospital

Golisano Children’s Hospital

caring people, caring for kids

The Golisano Children’s Hospital of Southwest Florida

The Golisano Children’s Hospital of Southwest Florida

Best outcomes in Florida for 1,000+ gram

infants (2.2+ lbs.)

The Little Hospital That Could!!!

TodayToday• Designated by the National Association of Children’s Hospitals and Related Institutions (NACHRI) • Only full service children’s hospital in SW Florida • Next closest Children’s Hospitals: Miami & St. Petersburg

(2.5 hour drive)• Ranked #1 in survival rate of NICU babies• Child Life Specialists including Music Therapy• Full-Time School Teacher• Community Abuse Injury Prevention Programs

America’s Newest Children’s Hospital

• 148 Private Beds/Suites– Neonatal Intensive Care Unit (64 suites)– Pediatric Intensive Care Unit (48 suites)– Inpatient Pediatric Oncology/Hematology Unit (12 suites)– Outpatient Pediatric Oncology/Hematology Unit (16 suites)– Pediatric Emergency Department (20 triage areas)– Sedation Rooms (10)

• Pediatric Pharmacy• Imaging (MRI, X-Ray, Procedure, Sleep)• Child Friendly Lobby• Educational Classroom for Chronic Patients• Family Resource Center• Innovative, family-centered, child/family-focused

Acute Care Inpatient Room

Golisano Children’s HospitalNeonatal & Pediatric Ambulance

Supported by Naples Children & Education Fund

• GCH serves the more severe and complex pediatric cases from SWFL including Collier County

• 27% of Collier County children who had to be hospitalized went to GCH

• 14% of Collier County babies born sick, small or too soon go the GCH Level II and Level III NICUs

• 24% of NICU patients from Collier County

• Thousands of Collier County Children impacted through the Health In Education Programs and Partners in Parenting Program funded by Naples Wine Fest

Golisano Children’s Hospital & Collier County

500+ Collier County children receive treatment monthly at the Golisano Pediatric Specialty Clinic •Located at Immokalee and Goodlett-Frank Road •More than 75% are Medicaid or Uninsured

• 2 full time Child Advocates; 1 part time Child Advocate Instructor • 3 areas of focus: • Health Education• Injury Prevention • Child Abuse Prevention

• Seeded initially by a grant in 2008 from the Naples Children & Education Foundation (NCEF)

• Currently funded by a combination of grants, philanthropy and Golisano Children’s operating budget

Golisano Injury Prevention … Collier County

•Child passenger safety free car seat check ups for the community (over 1500 car seats)• Including weekly Wednesday car seats checkups at NCH for

parents in the OB units• Distributed 600+ car seats to families at a reduced rate or

free of charge•Participation in 100s of health and safety fairs and community events in Collier

Attached are photos of some of our injury prevention efforts. Child passenger safety free car seat check ups for the community. We also check car seats at NCH on Wednesdays for parents in the OB units. Also a photo of our table/participation in health and safety fairs in Collier County. Photo of a Bike Rodeo, bike and helmet safety event.

In Collier County we've participated in hundreds of community events, we've checked over 1500 car seats, and distributed 600+ car seats to families at a reduced rate or free of charge.

Lessons in ParentingGolisano Children’s HospitalChildren’s Health Advocacy

Help Collier children in Collier

Golisano Partners in Parenting

•FREE parenting classes in Collier County•In partnership with Children's Advocacy Center of Collier County and with funding assistance from NCEF

• Plus many other Collier partners who help identify/refer families and provide classrooms

• Various communities/locations throughout Collier County•Offered for anyone who wants to be the best parent possible

• Offered in English, Spanish and Creole• Not for court ordered parents• Classes are 8 weeks for 2 1/2 hours per week• Free childcare and refreshments for the families during class

•Average of 900 parents and children each year in Collier County

• Health Education Programs to students in the Collier County elementary schools

• Supported by Suncoast Federal Credit Union Foundation• Average 7500 elementary school students annually in Collier

• Germaine the Germ Hand Washing Program - K and 1st grade• Body Safari Program - 2nd and 3rd grade• Mission Nutrition Program - 4th and 5th grade

Golisano Health Advocacy

Golisano Legislative Advocacy

LMHS Trauma CenterState Designated Trauma Center

• Lee, Charlotte, Hendry & Glades• 21% from Collier

Traumatic injury requires specialized and experienced multidisciplinary treatment and specialized resources across the care continuum.

Being treated at a Trauma Center increases a seriously injured patient’s chances of survival by an estimated 20 to 25 percent.

Trauma is the #1 killer of individuals between the ages of 1 - 44

Blunt 82%•Motor Vehicle Pedestrian•Bike•Assault

Penetrating 15% •Gunshot wounds•Stab wounds

Trauma

Burns 2%

Surgeons1.Trauma Surgeons2.Neurosurgeon3.Obstetric/gynecologic surgery4.Ophthalmic surgery5.Oral/maxillofacial surgery6.Orthopedic surgery7.ENT surgery8.Pediatric surgery 9.Plastic surgery10.Thoracic surgery11.Urologic surgery

Medicine Specialists1. Cardiology2. Hematology3. Infectious disease4. Internal medicine5. Nephrology6. Pathology7. Pediatrics8. Pulmonary medicine9. Radiology

Trauma Center ReadinessPhysicians on Call

Headline Goes Here

Trauma Center Injury Prevention OutreachEngagement of prehospital stakeholders• Act as Medical Care Council/Public Safety Administration resource• Establish and participate in prehospital protocol subcommittees• Provide regular EMS education – goal directed/evidence based• Perform prehospital QI (Collaborative reviews)Support acute care facilities• Develop / extend resources for the care of the injured patient (initial receiving facilities/64j)• Educate providers on initial resuscitation approach, and trauma transfer criteria• Provide feedback for acute care transfers into the TCOutreach and mentoring• Establishment of a peer mentoring and family support program• Facilitate annual survivors eventEngagement of community in injury prevention efforts• Regionalize injury prevention efforts• Establish injury prevention coalitions• Engage stakeholders to pursue community prevention based on local trends

• Collier County Injury Prevention Coalition established – Providing coordination of injury prevention efforts – Strategic planning and outreach/prevention activities – 50 agencies/organizations participating – Naples Chamber of Commerce actively engaged

• Distracted Driving Simulator• Senior fall prevention initiative “Step WiseCollier”

(adapted from Step WiseLee”)• “STOP Sports Injuries” campaign brought to Collier County • Collaboration with “Safe and Healthy Kids Coalition” • Collier County Adoption of Local Disaster Surge Plan

Lee Memorial Trauma CenterCollier Activities

Step WiseCollier

Distracted Driving Simulator Gulf Coast High School Naples (300 students)

Make Harm VisibleMake Harm Visible

Leverage the power of stories…the impact of transparency…

Ventilator BundleElevation of the head of the bed to 45°Daily sedation vacation and assessment of readiness to extubateDaily oral chlorhexidine rinsesProton pump inhibitors or H2 receptor antagonistsAnticoagulants or compression devices

Central Line BundleOptimal Site/Line SelectionHand HygieneChlorhexidine Skin AntisepsisMaximal Barrier Precautions at insertionAseptic Technique at Line Access and Dressing ChangesDaily Review of Line Necessity and Prompt Removal

Time-outs in the operating roomsSequenced checklist – identification, surgical site confirmation, procedure confirmation, etc.

“It Takes Two” campaign … system wide “Red Rule”

Examples of Standardization

Less than 4 serious safety events per 1 million adjusted patient days

Urinary Catheter Infection System rate less than 2 per 1000 Foley catheter days

Every Intensive Care Unit (ICU ) in the LMHS has gone a year or more without a Ventilator Associated Pneumonia

Central Line Infections system rate is less than 1 per 1000 central line days

(All ICUs at HealthPark Medical Center have gone a year without a Central Line Infection)

Results of Standardization

46

Patient Safety Begins with Me!And ends in ZERO!!!!!