Committed to Care: Levinson Heart Hospital’s New Arrhythmia Care Unit

Over the past decade, physicians and hospital teams have worked tirelessly to build the region’s premier center for heart care at Levinson Heart Hospital located on Chippenham’s campus. The collaborative approach to treating all aspects of heart patients was established with the vision of our electrophysiologists, cardiologists, and cardiac surgeons. This approach endures with the goal of continually offering state-of-the-art technology and personalized care.

This week, we opened the next exciting phase of Levinson Heart Hospital with the new $5 Million Arrhythmia Care Unit (ACU), a dedicated 10-bed step-down telemetry unit that serves patients with arrhythmia disturbances. The patient population will include a variety of post-procedure patients, such as those following pacemaker, ICD (implantable cardioverter defibrillator) insertions, and those that have undergone cardiac ablations. The private rooms each have telemetry monitors, with glass doors allowing for better patient and nurse visualization – similar to that of an Intensive Care Unit. The nurses have been trained on post-procedure care, so that patients are able to come to the unit directly from the procedure room, as opposed to going through a recovery area. The Arrhythmia Care Unit is clinically led by our four electrophysiologists: Dr. David Gilligan, Dr. John Onufer, Dr. Charles Joyner, and Dr. Saumil Shah.

Drs Gilligan & Joyner

Drs Gilligan & Joyner

Holly Kesel, Erica Day, Dr. Gilligan, & Kara Fisher

Holly Kesel, Erica Day, Dr. Gilligan, & Kara Fisher

I asked Dr. Gilligan why it was important to develop the unit. He said, “The new unit lays the foundation for us to build a medical and nursing expertise at a hospital that will surpass any in the region. Evidence shows that concentrating similar patients in one area builds stronger clinical expertise amongst the doctors and the nursing staff. This expansion will be an important foundation going forward for our atrial fibrillation center. In addition to creating dedicated care centers, our technology has improved dramatically over the last decade. For example, we are the only electrophysiology lab in Richmond that utilizes the Hansen Robot which allows physicians very precise and effective ablations. Utilizing this robot has improved our ability to perform complex ablation like no other in Richmond. National research shows that the combination of the aging population and increased sleep apnea (a cause of Afib) will lead more people to need specialized care in the future. This new project is another important step to expanding our expertise and gives us more dedicated treatment options than ever before. ”

In addition to the new Arrhythmia Care Unit, the hospital is in the process of building our

Arrhythmia Care Unit

Arrhythmia Care Unit

newest electrophysiology lab which will be addition to the existing program this summer. Special thanks to Tommy Byrd, Director of Engineering, and Holly Kessel, Nurse Director, for leading this project to completion. If you are in the hospital, please feel free to walk through the unit which is located on the 3rd floor of Levinson Heart Hospital.

Expanding Psychiatric Services in Richmond

It is hard not to be moved by the tragedies on the news related to individuals with mental health issues. In recent months, we have seen these issues come to the forefront regionally and nationally including the unfortunate attack of Senator Deeds in Southwest Virginia by his son. These issues highlight the need to improve and expand our mental health services to more proactively address acute situations. In 2013, the Governor appointed a task force to focus on developing a plan to improve mental health services in the state and crisis response. This was an important step to bring about awareness but it had already been something well on our mind, here at Chippenham & Johnston-Willis, and embedded in our strategic plan.

The facts on mental health are grim and concerning:

  •          Mood disorders afflict 9.5% of the US population
  •          A million adults attempt suicide each year; 30,000 of them succeed
  •          26% (43.7M) of Americans ages 18 and older suffer from a diagnosable mental disorder
  •          50% of all Americans develop a behavioral illness during their lifetime

To respond to this need, we will start construction of a $4.5M expansion of our Tucker Psychiatric Pavilion on the Chippenham campus this summer. The construction is expected to finish by April 2015. Tucker is a 113 inpatient bed facility and is the flagship of the Richmond metropolitan area for acute psychiatric services from child and adolescents through adult and geriatric. In 2013, Tucker admitted over 5,100 patients. Our caregivers and physicians see first-hand the positive impact they have on the lives of those in need.

We are confident that through this expansion we can start to close the gaps in mental health services and better serve the needs of patients in our community. We gave careful thought as to how best to move Tucker Pavilion services to improve access, quality, and outcomes for individuals in need of psychiatric inpatient care. This new design will move the 24 bed child and adolescent services into a dedicated wing of brand new, state-of-the-art space. The move will also allow us to have more flexibility in the remaining services to accept more patients.

We will keep you posted on the project as it progresses.

In Praise of Slowness

A bonsai tree can take up to 10 years to mature fully

A bonsai tree can take up to 10 years to mature fully

I recently read a book by Carl Honore called In Praise of Slowness. It reminded me of how important it is to slow down and focus on the relationships in our lives and not the endless tasks of our day. So here are some key lessons I took away from the book.

We now live in a world of instant gratification and even that isn’t always fast enough. Think back to the days when you had to use 35mm film cameras. It took weeks or months to finish a roll of film and then even longer to get it developed. We were used to that pace. Now we not only have digital cameras that immediately print, but we have our smart phones that enable us to instantly link our endless pictures to our Facebook account. We seem to never be satisfied.

According to Honore, we have moved from a world where the big eat the small to one where the fast eat the slow. Our obsession with speed has gone too far. It has turned into an addiction. Let me give you some examples: Your diet’s not working fast enough – get liposuction. Your food’s not heating up quickly enough in the oven – try a microwave. You want strawberries in winter – get them from South America. You want to produce more meat – grow the animal faster with steroids and endless corn. (Today a 220 pound pig can be grown in 6 months. Two centuries ago, it took 5 years to grow a 130 pound pig.) Even our food can’t come fast enough. The average person eats their McDonald’s meal in 11 minutes. Fast food revolutionized getting the food fast but I don’t believe it was meant to shorten the time it took to eat it. Most things are better slow. If I offered you a great glass of wine – would you drink it as fast as you could or would you savor the taste and enjoy the moment?

The evidence suggests we learn and build rapport better at a slower pace. While speed dating might be an interesting way to meet a lot of people in a short period of time – it is less likely to make a lasting connection than quality one-to-one time.

So why do we need to slow down? By stopping to “smell the roses” we make better connections with our co-workers and, perhaps more importantly, with our patients. Think about one of your visits to the doctor. Did they go down a check list to assess your physical symptoms and then grab the script pad to write a medication to fix your problem or did they really think about you holistically and consider your mental state of mind and all of the softer variables that might impact your physical health? Not everything can be solved instantly. Focusing on slowness often means better health, better work, better business, and better family life. Evidence shows that people who work 60 hours per week are twice as likely to have a heart attack as those who work 40 hours.

So here are the solutions Honore suggests:

  •          Relax – focus on the goal by decelerating
  •          Put aside impatience
  •          Create an environment where you resist the pressure to live by the clock and live fast. Enjoy each moment as it comes

My conclusion from the book was that we need to continually focus on making meaningful personal connections and not be obsessed with getting more tasks done. I often fail at this because I overload my day with too many tasks and allow too little time to foster relationships. The secret is balance: instead of doing everything faster, do everything at the right speed.

I realize in the hospital world we have to work fast as the sheer number of tasks to be done quickly stack up. What I am suggesting is that by working smarter, prioritizing our tasks, and spinning off the non-essentials we can spend more time establishing strong connections.

What do you think about the power of being mindful of slowing down? 

Affordable Care Act: The Conversation Continues

Last week, I had the opportunity to participate in a meeting at the White House with a group called The White House Business Council. This meeting was created to facilitate a meaningful two-way dialogue between business leaders from around the country and Senior Obama officials about how to best shape the future of healthcare, health technology, and health innovation. It is clear that if we are successful in advancing these areas across the country, we can reduce healthcare costs and improve health outcomes.

I realize that when I mention the term Affordable Care Act (commonly referred to as “Obamacare”) it stirs a lot of mixed emotions. I am not trying to be political, only to recognize that the law exists and we need to continually participate in the discussion to create better policy in the future. I openly admit that I am a supporter of getting more of our population insured. The 15% of our nation who is uninsured has been a notable failure in the US health system for decades and it is costing all of us in one way or another.

The feedback that was shared with the Obama Administration was that we are looking for more consistency in data-sharing and to focus more effort on results-oriented actions that can deliver better healthcare outcomes at manageable cost. The White House currently suggests that the first round of healthcare exchanges will cover 15 million more lives between the healthcare exchange and the expansion of some states’ (although not VA) Medicaid program. I hope they exceed their estimates.

After returning to Richmond, I looked up how much Chippenham & Johnston-Willis (CJW) Hospitals pay in un- and underinsured care. In 2013, CJW provided $250,000,000 in uncompensated care; charity care alone was approximately $68 million of that. At the same time, we paid state taxes of $14 million excluding payroll taxes. Our not-for-profit competitors are not subject to the same taxes although we are all obligated to care for the emergency needs of patients under the EMTALA laws. Our tax obligation is real money supporting both the state and the local economy. I bring this to your attention because I think it is important to give context to the public debate and recognition to the value of our organization to our community. Like you, I will be following the successes and failures of the Affordable Care Act in 2014 and beyond. The White House Business Council meeting was a great reminder of how important it is for all of us to be as involved in the debate as we are already involved in the care of those who need it most.

Celebrating Our Humanitarians: Frist Awards

 

This week, we held our annual recognition for the Frist Award, the highest award given in our company. Each year, there is a nomination process and the award is given to a physician, employee, and volunteer from each HCA hospital. The awards, created in 1971, honor individuals for their outstanding humanitarian and volunteer activities. This humanitarian award is given each year in recognition of the caring spirit and philanthropic work of the late Dr. Thomas Frist, Sr., a founder of HCA. Employees and volunteers who demonstrate extraordinary commitment and dedication to caregiving and their community are selected around the country and honorees are recognized at the local and national levels. These individuals embody the culture of Chippenham and Johnston-Willis.

 

 

Stephanie Neal, VP of Human Resources; Gert; & Tim McManus, CEO

Stephanie Neal, VP of Human Resources; Gert; & Tim McManus, CEO

Volunteer Winner

Gert Palicia: Gert is known as a loyal volunteer who has been here for 13 years. She works here at least twice a week and is known for creating all of the window displays at the Chippenham gift shop. According to Maria Gilmore, Volunteer Director, Gert’s always willing to help in any way needed. Gert also volunteers at her church to feed the homeless by preparing and delivering meals to various sites throughout the county. She is a volunteer with impact.

 

Stephanie, Shawn, & Tim

Stephanie, Shawn, & Tim

Employee Winner

Shawn Fenner: Shawn is a nurse in our ICU at Johnston Willis. Nursing is his second career path and he is committed to his profession and his patients in many ways. Patients, families, and coworkers constantly praise his dedication to, not only the ICU team, but to the entire nursing team. He is focused on our patients and consistently lives our core service commitments in his work every day.

 

Stephanie, John, & Tim

Stephanie, John, & Tim

Physician winner

Dr. John Turner, Pathologist: John serves as a role model, coach, and advocate as a member of the not-for-profit, Sportable Team. This organization creates opportunities to transform the lives of individuals with physical and visual disabilities through sport by providing adaptive sports and recreation opportunities in Richmond. One of the children who works with John in the swimming pool attended the ceremony and it was clear that he is truly impacting lives.

I appreciate the dedication of Gert, Dr. Turner, and Shawn. There are clearly difference makers in and outside of our hospitals.

A Hero in Our Midst

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It is award season and hard to miss individuals being recognized for their talents. If you are like me, hearing who won best actor or best cinematography has no lasting impact. It is mildly interesting but inconsequential to most people. What I do get excited about is hearing about heroes, people who step up to make a lasting difference in other people’s lives. Sometimes it is a small thing that raises an individual to the Hero status but usually it is something life changing. I can honestly say that watching award shows such as “CNN Heroes: An All-Star Tribute” reminds me that difference makers are personally motivated to impact others. These people accomplish so much because of their immense dedication and focused determination.

It is a pleasure to share with you a hero in our midst. Adele Fernandez is a nurse in our cardiac rehab program. She has been a nurse since 1979 and working at Chippenham & Johnston-Willis Hospitals since 1984. Her patients love her. In the past year, I have personally received numerous letters which share high praise for her compassion and service. Many of her cardiac rehab patients would gladly tell you she is their hero because of what she and her associates have done to get them back to health. She has historically been very active in the American Heart Association’s annual heart walk. She recently shared her perspective of the heart walk by saying, “We (she and her patients) weren’t the fastest, but it was our best…I have literally cried as I have seen patients who had recently experienced heart events cross that finish line with me.”

Adele stepped up again to be a hero on February 19th. She was shopping in a local grocery store. She heard an announcement over the intercom for any nurse or CPR certified person to come to Customer Service. As she approached she found a middle age person unconscious just inside the entrance door. The manager called 911. Adele with her years of experience went from customer to cardiac nurse and assessed the patient’s condition and started CPR. She called for the store’s AED, which was applied and indicated a shock was required. The patient was shocked and a heart rhythm established. The patient started coming to as the ambulance arrived. It was clear that if Adele had not acted swiftly, the outcome for this shopper/patient would have been extremely different. The patient went on to a hospital and is now on the path to full recovery.

So this week, I salute Adele Fernandez for being a difference maker. That family will always remember their good fortune to have a Hero from Chippenham & Johnston-Willis at the right place, at the right time, with the right skills, and the right courage.

Dr. Zocco: A long, prestigious career comes to a close

Aside

Dr. ZoccoThis week, I spoke to Dr. Jim Zocco, Cardiovascular Surgeon and Board Member, about his pending retirement from clinical practice next month. He has worked for over three decades in Richmond and is considered by many to be one of the great patriarchs of the profession.

Tim: What made you choose cardiovascular surgery? If you were going to do it all over again, would you have chosen the same specialty?

Dr. Zocco: I would definitely choose the same specialty. I was lucky when I trained at MCV, I had some great mentors. Dr. Richard Lower inspired me during my training; he was instrumental developing heart transplation. I recall him as being unassuming while being incredibly bright. He was someone I looked up to technically. I knew then that I wanted to do heart surgery from watching Dr. Lower. His work was precise and I enjoyed dealing with patients that were acutely sick in intensive care.

Tim: You have seen Chippenham & Johnson-Willis Hospitals evolve into one of the premier Heart Centers in the state. What do you attribute that evolution to?

Dr. Zocco: It comes down to the staff. We have always had one of the best medical staffs. It takes all those components to make it work: anesthesia, Infectious Disease, pulmonary, renal, cardiology. We have always had the best team in the Operating Room and Intensive Care Unit. Through the years, even when there was turnover, it is really the people who have made us successful. HCA has been instrumental to supporting our growth. We also couldn’t be successful without the superb nursing services. My physician partners have also been great, we are lucky to have assembled a talented team. I would hold their credentials and skills up to anywhere in the country.

Tim: Serving on the Board of Directors for 15 years has given you a different perspective of the organization. What do you hear in those meetings that might surprise others?

Dr. Zocco: The commitment to growth and to making our hospitals #1 in the area. People don’t always understand our focus on quality and interest in being on the leading edge of medicine. I have always been impressed that the Board demands excellence from the medical staff. None of this happens by accident. The Board has done a good job leading by listening to the medical staff for what is required to be an excellent facility.

Tim: You and your colleagues were largely responsible for getting the Levinson Heart Hospital built over 10 years ago. What was the original vision?

Dr. Zocco: We had received one of the first Health Grades awards, everyone was very excited. But, to be honest, it wasn’t our best year. Although we achieved this award, there was more that was needed to improve. We knew we needed to evolve to another level. The idea was born to have a heart hospital. Our vision was that we could build a heart hospital that produced quality at the level of the Cleveland Clinic. We knew it could be a dominate force in the state and the southeast.

Tim: What advice would you give to a new physician just completing their training in 2014?

Dr. Zocco: Several things. Number one, don’t get hung up on the politics of medical care. Whatever is going to be, is going to be. If you don’t like what is being done at the national or state level then you need to figure out how to work within that system to continue the focus on quality. Secondly, technology is changing so rapidly, you have to keep up. It is critical that physicians use continuing medical education credits to really maximize. Third: Don’t forget the patient, that relationship is so important. There are so many obstacles to interacting with the patients but that relationship is the core of what we do. You can’t accomplish what we need to do without a good understanding of the patient and them putting their trust in you. Sometimes the technology and regulations start making the patient get lost. Doctors have to establish that relationship by doing what is right for the patient.

Tim: People outside of healthcare might not realize the significant time commitment and sacrifice required to be a surgeon. How did you find balance between work and family?

Dr. Zocco: Unfortunately, it is difficult to achieve that balance. I don’t feel I was successful at it. I would have rather spent more time with my family. In this job, you don’t always have a choice but to put the patient first. You can’t easily leave town or watch your child’s play when you have a patient in need. I have no regrets, but it is one of the reasons I am going to retire. If someone is sick it trumps everything.

Tim: You have always been on the cutting edge of medicine. What would you guess heart surgery will look like decades from now?

Dr. Zocco: I think it will be completely different. There is a good chance that a significant portion of it will be done by a differently trained surgeon. A lot of what is coming down the line isn’t classic surgical training. There is more endovascular surgery, purcutanous treatment. The doctors needed in the future will need to pick up a lot more skills that we are just beginning to get into now. Transcather valve surgery is an example. In addition, they will still need to be able to do open heart surgery. The surgeon in the future will need to be a better surgeon than we had to be during my career.

Tim: By serving on the Board of Directors for Chippenham & Johnston-Willis Hospitals you have been able to advise a number of CEOs. What advice do you have today?

Dr. Zocco: My advice today is to rekindle the vision of the Levinson Heart Hospital. We need to make sure we stay on the cutting edge of new technology. It takes continued investment. For the hospital in general, it is important to continue doing what you are doing for the quality initiatives. It is important that this hospital distinguishes itself from other community hospitals by being a true tertiary care center. In the future there will be a lot of pressure by the government and payors to only send patients to certain facilities for the more complicated procedures. We want to be sure we are one of them.

If you have a comment or story to share about Dr. Zocco, please share it here on the blog.