Hospitalist Program
Intensivist Program
Technology and Latest Procedures
Research Efforts
Case Management
Patient and Family-Centered Care
Code of Conduct
Medication Reconciliation
Electronic Medical Record
Institute for Healthcare Improvement - 5 Million Lives Campaign

Hospitalist Program
Hospitalists are internal medicine physicians who provide patient care in a hospital setting only. They work collaboratively with the primary physician or other specialists as needed to ensure consistent care, and they keep the referring physician informed during the patient's hospital stay. They also are extremely knowledgeable in the discharge services available to patients.

A national study of hospitalist programs showed that hospitalists help to reduce patients' length of stay, readmissions and health care costs, while improving the quality and consistency of care. St. Cloud Hospital began its hospitalist program in 2001, and has had similar quality improvement results as those found in the national study.

Intensivist Program
St. Cloud Hospital was one of the first hospitals in Minnesota to offer an intensivist-directed Intensive Care Unit (ICU). An intensivist is a physician who is trained and certified in the specialty of Critical Care Medicine. An intensivist-directed ICU program ensures all patients receive evidence-based, best practice medicine. Standardization of care practices improves quality of care, outcomes and costs.

An intensivist-directed ICU is a national standard set forth by the Leapfrog Group, a national organization formed by top businesses to reduce medical mistakes and improve the quality and affordability of health care. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) supports this initiative.

Technology and Latest Procedures
St. Cloud Hospital provides the latest technology for its increasingly sophisticated and specialized medical staff. This is both a benefit for our patients and an attractor for the best medical talent in the region.

Examples of recently acquired, state-of-the-art technology at St. Cloud Hospital include:

• Arctic Sun cooling device used to treat certain heart attack patients with the goal of preventing brain damage and increasing survival rates following a heart attack.
• da Vinci Robotic Surgical System.
• Multi-slice CT scanners that make diagnostic heart and peripheral vascular studies safer and less invasive.
• Positron Emissions Technology (PET) scanner to aid in the advanced diagnosis and treatment evaluation for patients with cancer.
• Minimally invasive surgery for joint replacement.
• Image-guided sinus surgery.
• New MRI scanner (among the first 10 in the country) that offers higher speed and improved resolution.

Research Efforts
Research can help give patients access to the latest, cutting-edge treatments. These treatments can ultimately help to improve the quality of care patients receive.

Research in the form of clinical trials at the Central Minnesota Heart Center has focused on new defibrillators, new medications to treat heart attacks, lipid-lowering medications, safety of stent procedures and medications to reduce cardiac risk for people with diabetes.

Research at Coborn Cancer Center has included clinical trials of investigational drugs and vaccines, devices and procedures. Coborn Cancer Center is a member of the North Central Cancer Treatment Group (NCCTG), a nationally recognized clinical research group that works with cancer specialists at leading treatment centers in the U.S.

Nursing research is promoted as a part of practice at St. Cloud Hospital, and is supported by a Nursing Research Committee that promotes a philosophy of evidence-based practice. There is an increasing emphasis on using research as part of clinical and administrative decision-making. St. Cloud Hospital has a very active performance improvement program in which staff nurses are involved in reviewing nursing practice, asking “questions” and collecting/analyzing clinical data. Staff RNs are encouraged to actively participate in planning and implementing practice changes based on research.

St. Cloud Hospital has an Institutional Review Board (IRB) that is charged with the review, approval and monitoring of research protocols. The IRB ensures appropriate informed consent takes place, and it protects the rights of all patients involved in research and investigational protocols.

Case Management
Case management is not a profession in itself, but an area of practice within one’s profession. Its underlying premise is that when an individual reaches the optimum level of wellness and functional capability, everyone benefits: the individuals being served, their support systems, the health care delivery systems and the various reimbursement sources.

St. Cloud Hospital offers case-management services to every patient. The RN (or primary care giver) determines the coordination of care level necessary and refers to a case manager as appropriate based on the defined criteria. All members of the care team identify opportunities for improved clinical utilization of resources while maintaining desired outcomes.

Several roles are necessary to have a successful case management system. Each role offers a unique contribution.

Patient and Family-Centered Care
Patient and family-centered care is an approach to the planning, delivery and evaluation of health care that is grounded in mutually beneficial partnerships among patients, families and health care practitioners. It is founded on the understanding that the family plays a vital role in ensuring the health and well-being of patients of all ages. The ultimate goal is to create partnerships among health care practitioners, patients and families that will lead to the best outcomes and enhance the quality and safety of health care.

Studies have shown that patient and family-centered care can help to improve clinical outcomes, reduce length of stay and improve the overall quality of care.

Patient and family-centered care is based on four guiding principles:

Code of Conduct
A Code of Conduct has been adopted by the St. Cloud Hospital Board of Directors to provide standards by which hospital employees and physicians will conduct themselves. The Code of Conduct supports our culture of patient safety by encouraging employees and physicians to speak up and ask questions when patient safety concerns arise.

Medication Reconciliation
Medication Reconciliation is a process of determining all the medications that a patient is on at home, when she is admitted to the hospital and discharged. Modern pharmacologic medications are very powerful. They are tremendously effective but can also be very dangerous if not taken in the exact dose, considering all possible interactions. It is not uncommon for a patient to bring a paper bag to the hospital full of medications dating back 10 years. The patient’s current medications may not be readily apparent and making assumptions can be dangerous.

Medication Reconciliation is a complex process involving nurse, pharmacist and physician time. Many patients are unfamiliar with their medications and some have memory impairment. In addition, patients may have many physicians (primary care and subspecialists), and medication changes are often made by phone rather than at a physician visit. Many seniors do not have a single pharmacy for their meds and may order them from a variety of mail-order pharmacies. Also, many patients are taking herbal and botanical agents, such as garlic, that may interfere with medications they receive in the hospital. It is more than theoretical that a patient, for example, may be on two different types of digitalis after hospital discharge – a double and life-threatening dose. A thorough search to identify all the medications and herbal agents a patient is taking, can eliminate this possibility.

Electronic Medical Record
CentraCare Health System already has many of the individual components of an electronic medical record. Once a patient is admitted to St. Cloud Hospital, each physician involved in his/her care may access important portions of the medical record from any Hospital computer or even at home through a special secure connection. This helps tremendously in coordinating complex medical care among the many caregivers involved in a patient’s care. The results of laboratory studies are posted to the electronic record as soon as the lab completes them. In addition, physicians may view the patient’s X-ray studies on the computer monitor along with the radiologist’s expert interpretation of the study. All discharge summaries are accessible on-line and our physicians even sign their reports electronically.

The security surrounding this system is governed by a Federal Law known by its acronym, HIPAA, which limits access to your medical record to those involved in your care. All others must obtain your permission to access any of your information. You are in control of who sees your information.

CentraCare Health System is in the process of developing the electronic capability of our electronic medical record even further to:

• allow physicians to order medications by computer (enhanced safety and a great time-saver);
• check medication administration through bar-coding to a patient wristband (enhanced safety);
• allow nurses, technologists and physicians to enter data directly into the electronic record facilitating instantaneous access by other caregivers.

Institute for Healthcare Improvement - 5 Million Lives Campaign
The 5 Million Lives Campaign will be the largest improvement initiative undertaken in recent history by the health care industry.

St. Cloud Hospital has chosen to participate in the Campaign and adopt 12 changes in care that save lives and reduce patient injuries.

The first six interventions are from the IHI's 100,000 Lives Campaign, launched in 2003:

• Deploy Rapid Response Teams – by allowing any staff member, regardless of position in the chain of command, to call upon a specialty team to examine a patient at the first sign of decline;
• Deliver Reliable Evidence-Based Care for Acute Myocardial Infarction – by consistently delivering key measures -- including early administration of aspirin and beta-blockers – that prevent patient deaths from heart attack; 
• Prevent Adverse Drug Events – by implementing medication reconciliation, which requires that a list of all of a patient’s medications (even for unrelated illnesses) be compiled and reconciled to ensure that the patient is given (or prescribed) the right medications at the correct dosages -- at admission, discharge and before transferring a patient to another care unit; 
• Prevent Central Line Infections – by consistently delivering five interdependent, scientifically grounded steps collectively called the “Central Line Bundle”;
• Prevent Surgical Site Infections – by reliably delivering the correct perioperative antibiotics, maintaining glucose levels and avoiding shaving hair at the surgical site;
• Prevent Ventilator-Associated Pneumonia – by implementing five interdependent, scientifically grounded steps collectively called the “Ventilator Bundle” – such as elevating the head of the hospital bed by 30 degrees – thereby dramatically reducing mortality and length of stay in the Intensive Care Unit.

Plus six new interventions introduced in 2007 as part of the 5 Million Lives Campaign:

• Prevent Harm from High-Alert Medications - by focusing on anticoagulants, sedatives, narcotics and insulin;
• Reduce Surgical Complications - by reliably implementing all of the changes in the Surgical Care Improvement Project;
• Prevent Pressure Ulcers - by reliably using science-based guidelines for their prevention;
• Reduce Methicillin-Resistant Staphylococcus aureus (MRSA) infection - by reliably implementing scientifically proven infection control practices;
• Deliver Reliable, Evidence-Based Care for Congestive Heart Failure;
• Get Boards on Board - by defining and spreading the best-known leveraged processes for hospital boards of directors so they can become far more effective in accelerating organizational progress toward safe care.

The Institute for Healthcare Improvement (IHI) is a not-for-profit organization that works to improve the quality and value of health care by focusing on safety, effectiveness, patient-centeredness, timeliness, efficiency and equity. St. Cloud Hospital is participating with VHA in implementing the practices.