Electronic medical records up and running

Doctors at Wise Regional Health System are posting an average of 1,800 orders per day electronically, using the new electronic medical records system installed over the past year.

The hospital’s board of directors got that information in a report at its Jan. 27 meeting from Jennifer Graham, director of clinical and ancillary applications.

Graham said the installation of the paperless electronic health information system was a significant step in meeting federal requirements that all health-care providers convert to electronic medical records.

Wise Regional has installed more than 80 new computer terminals throughout the facility for use by physicians and nurses to both input and access patient information. Technical staff is on call around the clock to support the system, which is backed up nightly and is also backed up off-site on a monthly basis.

Graham said despite the large amount of changes involved, the system is working well.

Implementation of that system, along with equipment purchases for the new Parkway Surgical and Cardiovascular Hospital in Fort Worth, accounted for most of the $8 million increase in capital purchases the hospital system saw last year, according to Chief Financial Officer Jim Eaton.

Eaton noted the system posted an $800,000 gain from operations in December, with the net loss from the Bridgeport facility falling to $237,000. That reflects the cutback in services there to emergency and outpatient only.

FACILITIES STUDIES UNDERWAY

CEO Steve Summers reported the board will be having a retreat in the next few months to review the recent Community Health Needs Assessment and discuss planning for the hospital system’s future growth.

He noted plans for a new Air Evac headquarters have been sent to the city of Decatur and said he expects the helicopter ambulance system will start building as soon as approvals are received. The addition, which will be in a separate building, will create more room inside the hospital for the expansion of the outpatient imaging department.

Board member Mark Duncum reported the hospital continues to work toward refinancing $55 million of its bonded debt – approximately 75 percent of the total – with the remaining 25 percent to be refinanced in September. Rating agencies have been invited to consider the hospital’s bond rating.

A lower, investment-grade bond rating would substantially reduce the hospital’s interest payments.

The building committee is also looking at future facilities requirements in Decatur and believes within the next four to five years, additional beds and surgical space will be needed on the main campus. To meet that need, the refinancing project calls for $10 million in new debt that would be used to construct a new physical therapy/sports medicine/fitness facility.

That facility, located in a stand-alone building on the hospital campus, would free up significant space in the north wing of the hospital, which could then be used for an expansion of beds and surgery space.

OTHER BUSINESS

  • Summers told the board an unannounced inspection of the Intensive Outpatient Program at Behavioral Health Services by the Joint Commission on Hospital Accreditation resulted in only six recommendations out of 1,200 standards the unit is required to meet.
  • Chief nursing officer Sue Sewell noted that Wise Regional employs 322 RNs, 64 LVNs and 157 ancillary nursing employees in 12 departments. She said the facility handled 7,696 surgical cases in 2013 – a 15 percent increase over the previous year.

The board also:

  • approved replacing two air handler units on the West Campus at a cost of $317,510, and OK’d another $2,967,366 to purchase additional equipment for the Parkway facility, including an $800,000 portable CT unit.
  • approved recruiting a neurosurgeon to provide services at both the Decatur and Parkway campuses.
  • approved new appointments to the medical staff based on the recommendations of the Medical Executive Committee and accepted the medical staff’s annual review of various medical service contracts.

The board’s next meeting is 6 p.m. Monday, Feb. 24, in the administration board room at 609 Medical Center Drive in Decatur. The meetings are open to the public.

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Community Health Clinic begins extended hours

Wise County now has a new after-hours health care provider.

The Clinical Care Associates Community Health Clinic in Decatur is now open 8 a.m. to 8 p.m. Monday through Friday as well as 8 a.m. to noon on Saturday. Previously, the clinic was only open 8 a.m. to 5 p.m. Monday through Friday.

New Look

NEW LOOK – Lisa Read, director of clinic operations, and Paul Aslin, chief operating officer of Wise Clinical Care Associates show off some of the new signs at the Clinical Care Associates Community Health Clinic. The clinic began evening and weekend hours this week. Messenger photo by Joe Duty

The clinic is able to offer the extended hours because it has added a second provider. Laura Moore, a nurse practitioner, has been serving since last October. On Monday, Alissa Sobieraj, a physician assistant, also began work at the clinic.

The Community Health Clinic has operated as a branch of Wise Regional Health System’s Clinical Care Associates since Oct. 1 of last year. Prior to that it had been run by North Texas Area Community Health Centers Inc.

While the clinic was created in early 2012 mostly with local funds in hopes of being federally funded, it did not qualify for federal grants. Wise Regional stepped in to keep the facility open.

“Our community clinic is a good way to reach out to our Wise County community, not only to help the insured but the uninsured,” said Lisa Read, director of clinic operations. “Our main purpose or goal is to reach out to that uninsured population.”

The clinic also accepts Medicare and Medicaid.

Patients are billed for services based on a sliding scale according to family size and income levels. If the patient is still unable to pay, they will not be turned away according to Paul Aslin, chief operating officer of Wise Clinical Care Associates.

Because it no longer receives federal funds, the clinic must rely on donations to make up the difference.

While the clinic typically sees between 120 and 150 patients a month currently, that could increase to about 400 now that a second provider is on the job, Aslin said.

The Community Health Clinic is located in the old emergency room on the WRHS West Campus, 2000 S. Farm Road 51. Its new phone number is 940-626-3888.

For information on the clinic or the services offered, visit ClinicalCareAssoc.com.

To make a donation to the clinic, call the number listed above.

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Extending its footprint: Wise Regional’s Parkway hospital nears opening on I-35 in Fort Worth

The announcement was made in August 2012, and a groundbreaking ceremony was held that fall.

Wise Regional Health System’s board has been approving equipment orders for more than a year.

The WRHS website even touts it – “Opening in 2014!”

Big Cath Lab

BIG CATH LAB – Folks get a tour of the cath lab at Parkway Hospital, off I-35 in Fort Worth. Messenger photo by Joe Duty

But until you step through the doors of Parkway Surgical and Cardiovascular Hospital, located off Interstate 35 at North Tarrant Parkway, you don’t fully grasp that the Decatur-based health care system will soon be operating a state-of-the-art surgery center outside of Wise County.

The new Parkway Hospital is in Tarrant County, one exit north of the intersection of U.S. 81/287 and I-35. It is designed to serve the booming Alliance area, the focus of much of the Metroplex’s growth over the last decade.

But it will certainly boost medical care in Wise County, too.

For one, it should be a profit center, with a higher percentage of private-pay patients that will help WRHS continue to provide care in Decatur, Bridgeport and throughout its service area.

The facility will also allow WRHS physicians to perform procedures they can’t currently offer in Decatur – a benefit for doctors and patients.

Delicate Operation

DELICATE OPERATION – A worker makes his way through the post-op area at Wise Regional’s Parkway surgical hospital, which is slated to open this spring. Messenger photo by Joe Duty

The nearly 30,000-square-foot hospital has four operating rooms, two procedure rooms including a cavernous cath lab and 12 inpatient beds. It also has a kitchen, pharmacy, laboratory, radiology and preoperative services as well as an emergency room.

Denise Scurlock, administrative director for the new facility, just came over from Baylor Jan. 2. She is excited about the hospital.

READY TO OPEN – Denise Scarlock, administration director, is excited about the new hospital’s opening this spring. Messenger photo by Joe Duty

“It’s beautiful,” she said on a tour this week. “I’m very impressed with the work and the detail they’ve put into this.”

The building is getting the final touches now – most of the equipment is either in place or sitting in boxes awaiting installation as workers drop in ceiling tiles, check plumbing and get various other systems up and running. After the punch-list and site work are completed, Wise Regional will get the keys and work for a few more weeks before opening to the public sometime in March or April.

“I’m very impressed with all they’ve done,” Scurlock said. “It’s amazing.”

The Parkway hospital will provide surgical services in spine, orthopedic, cardiology, plastic surgery, pain and gastroenterology. It’s built to be expandable – three more ORs and 12 more patient rooms could be added quickly if the expected growth materializes. And while Wise Regional is leasing the building to start, they have an option to buy it within three years.

Scurlock said the facility is designed around patients.

“It’s patient-centered to make sure it flows in a way that’s best for the patients and the physicians and what they’re really ultimately here to do,” she said. “The primary focus is on that.”

Families will find the patient rooms noticeably bigger than in most hospitals, and the appointments are first-class. But it’s a doctor’s dream, too.

“Any cardiac physician would come into that cath lab and their jaw would drop,” Scurlock said, noting the size, the lighting, equipment for anesthesiology and X-ray.

“This is equipment that not a lot of cath labs have in this area,” she said. “This is an upgrade even from what they’re able to do at Wise Regional in Decatur.”

But, she pointed out, it’s the same hospital, operating under the same license with the same staff.

“They’ll also be putting in devices, pacemakers, also diagnostic heart caths, stent placements – there’s a plan to grow this entire hospital as time goes on.”

The hospital will also offer minimally invasive spine, pain surgery, plastic surgery, vascular surgery, bariatric surgery, orthopedics and podiatry.

Also under construction on the site are several physicians’ office buildings – including space for a Fit-N-Wise fitness center and therapy location.

Parkway Surgical Hospital, which was projected to cost $12.8 million, is expected to employ 35 full-time people and account for more than 800 outpatient surgical procedures in its first nine months of operation in 2014.

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Speed saves: Medical app gets first test on New Year’s Day

If you have a heart attack, it won’t be a fast ambulance, a big hospital or high-tech gadgets that save your life.

It will be people.

But if you live in Wise County, you can be sure those people will have fast ambulances, a big hospital and some really high-tech gadgets – including a new application for their smartphones.

ON THE CLOCK – Wise County EMS Paramedics show the iPad with the Stop STEMI app opened on the screen. The application notifies the team and speeds the process of getting a heart attack victim into the cath lab for a lifesaving medical procedure. Messenger photo by Joe Duty

On New Year’s Day at 4 a.m., Wise Regional Health System’s heart-attack response team for the first time used this new “app” that helps speed up response times when someone has a STEMI – a heart attack caused by a prolonged blockage of blood supply to the heart muscle.

Heart attacks – myocardial infarctions, or MI’s – are always emergencies, but most can be treated with medication. But a STEMI, which creates a distinctive signature on an electrocardiogram (EKG), requires more drastic action. Those patients go to the cath lab, where a cardiologist inserts a “wire” up through the femoral artery into the clogged vessel, then unclogs it with a balloon – angioplasty – or a stent that props the vessel open.

Until that’s done, the heart muscle continues to suffer damage.

Lee Ann Cummings, registered nurse and director of the ER at Wise Regional, explained that on an EKG, a STEMI looks like a tombstone (see graphic at right).

“That means the heart is starving for oxygen, and you are infarcting,” she said. “Anytime there’s a STEMI and we’re watching it, that is emergent. That is actual damage being done to the heart muscle, and we want that to come down.”

The Stop STEMI app, developed by CommuniCare Technology, based in Longview, is designed to streamline communication among caregivers and reduce the time between the first medical contact with the patient and the restoration of normal blood flow to the heart. The program shares critical patient information among paramedics, the emergency department, the cath lab team, cardiologists and the cardiac care unit.

Cummings said the new app is simple and visual.

“EMS responds on the scene, they do an EKG, they take a picture of the EKG, put in the patient’s first name, last name, age and gender and boom! They send it to us,” she said. “The ER charge nurse logs in with her iPad with the STEMI app, and then a siren goes off. They look at it and acknowledge it. If Wise County EMS is telling us it’s a STEMI, we’re going with it.”

One of its key features is a clock that shows everyone involved exactly how long they’ve been working on the patient.

The national standard is to have a cardiac intervention done within 90 minutes. That clock used to start when the patient entered the hospital, but now it starts at the first medical contact.

On New Year’s Day, the Wise Regional team did it in 82 minutes.

“That’s good considering it was 4 o’clock in the morning on a holiday,” Cummings said.

ER Manager Kellye Souther, RN, said Wise Regional is only the second hospital to use the Stop STEMI app, which just came out last fall.

It was a connection with one of the company’s top people that brought the app here.

“BLOWN AWAY” BY THE PRODUCT

Shane Elmore, RN, is the director of business development for CommuniCare.

“I worked in the ICU, the ER and flew out of Wise Regional with Air Evac for about a year-and-a-half,” he said. He left in September 2011 and went to work at Trinity Mother Frances Hospital in Tyler, focusing on STEMI cases. Last September Dr. James Woodson, M.D., who heads up CommuniCare, came and presented the app there.

“I was blown away by this product,” Elmore said. “We started using it, and I immediately thought Wise Regional was the perfect place because of the ER staff, you have Advanced Heart Care with the cardiologists and the ongoing relationship with Wise County EMS.”

Woodson, a board-certified ER physician, and Elmore are now both full-time with CommuniCare, which is releasing the Stop STEMI app nationwide.

“The traditional way, all this information is going to go through two or three gatekeepers,” Elmore said. “With this, they all get it at the same time. Everyone sees that clock, and everyone knows where they are in the process.

“It unites the team.”

When someone calls 911, an ambulance is dispatched. Depending on where they are in Wise County’s 923 square miles, it can be 20 minutes or so before paramedics arrive.

When they determine the patient is having a heart attack, paramedics follow protocols that include administering certain medications and doing an EKG. They take a picture of the printout with their phone and send it to the ER along with the patient’s name, age and gender.

If it’s a STEMI, a lot of people start scrambling.

Cummings said this is where the Stop STEMI app eliminates a lot of little time-wasters.

“In the past, cath lab calls down, ‘Do you know the name? Do you know the age? Do you know how far out they are?'” she said. “With this app, everybody sees that information, including the EKG. It uses GPS and tells us an estimated time of arrival.”

Eliminating all that calling and checking saves valuable time – and lives.

TEAMWORK IS THE KEY

Cummings and Souther have high praise for Wise County EMS and the way they and hospital personnel work together.

“The EMS here is so amazing,” Cummings said. “That’s what’s so different about our program.”

WCEMS follows the same protocols as Wise Regional ER – they even use the same IV pumps and lines, so those don’t have to be changed once the patient arrives. They also train together, and several EMS personnel work in the hospital when they’re not on the ambulance.

The end result, for patients, is a team that’s all on the same page.

“A lot of places, no one can agree,” she said. “You have different EMS systems and whatnot, and they’re like, ‘Yeah, we’ll give an aspirin and we’ll do this, but we’re not going to give all those meds.’ There’s all these little things that increase your times.”

Souther said that doesn’t happen here.

“Some people have to take it to the ER doctor and say, ‘Do you think the medics are right?’ but with us it’s like, if they say it’s a STEMI, it’s a STEMI,” she said.

“That’s why a lot of other places, their times are not as good because the ER docs are just not as cooperative,” Cummings said.

“The medics are wrong in other places, but our guys aren’t,” Souther added.

Charles Dillard, WCEMS director, said his service’s relationship with Wise Regional is “excellent.”

“When the paramedics say, ‘Hey, here’s what I’ve got,’ just off his word they’ve been able to go ahead and activate the STEMI team,” he said. “That’s not seen in a lot of other places. There’s a lot of trust that goes into that.”

EMS crews bring patients all the way into the cath lab, help get them set up and often observe the procedure – and come back the next day to check on the patients in the CCU.

Most of the new ER nurses do ride-alongs with the ambulances, too – “to see their world a little bit,” Souther said.

“They come to our meetings, we discuss cases with them and find ways to improve – and it’s usually not on their end,” Cummings said. “They really, really do a great job.”

Dillard said his people work hard to relay accurate information.

“We try to make sure the people on the ambulance are able to look at the monitor, read the monitor and determine that this is or is not a STEMI,” he said. “We don’t want to call up here 100 times and five of them are STEMIs, and they’ve already activated the team. You’d kind of wear them out after a while.

“They’re pretty good at recognizing when it does need to go to the cath lab.”

Cummings said like any relationship, both the hospital and the EMS people work at it.

“We have a mutual respect, and we work hard,” she said. “The medics and the nurses, there’s an expectation that you treat each other with respect and professionalism. There’s been some people who got in trouble because they spoke unkindly to each other. We call them on the carpet for it.”

EARLY DETECTION, REACTION ARE CRITICAL

Of the 1.4 million heart attacks each year in the United States, roughly 400,000 are STEMIs. Souther said few come with no warning.

“From being in the ER for 20 years, most people do not just all of a sudden have a heart attack,” she said. “There’s Rolaids in their truck, they’ve been eating Tums for days, they felt a little weak, they felt a little nauseous – they usually have symptoms for five days before they have a heart attack.

“There’s very few people who just have a heart attack and die. They ignore the symptoms.”

Souther said most people who come to the ER are given an EKG just to make sure what they’re feeling isn’t an early warning of a heart attack.

“We have some people who come in and say, ‘I just don’t feel right.’ They feel weak, just a general nausea, heartburn, flu-like symptoms, elbow pain, finger pain – if something feels weird and different, that you haven’t felt before, we’re going to check it out,” she said. “These people who come in just with a generalized weakness, flu – everybody pretty much gets an EKG during flu season.”

She said because of the skill and technology EMS brings, it’s important to call 911 and get an ambulance if you suspect a heart attack.

“It’s hard to get out to the public that you need to call the ambulance because they say, ‘I can beat the ambulance there.’ But when you call them, your care starts from your house.”

Cummings said the geographical area the Wise County EMS covers makes that even more critical.

“If they respond, they’re already starting on the scene, activating,” she said. “If it’s a 20-minute transport, the cath lab can be just about here, set up and ready to go – as opposed to you driving here, then we have to call cath lab.”

Souther said a campaign to increase awareness of heart problems and encourage calling 911 began about four years ago and has had good results.

“About 50 percent of our population were walk-ins with heart attacks, and now we’re down to about 40 or 30 percent who are walking in,” she said. “So we do have more patients calling 911.”

Last Wednesday’s patient, like most, said she wishes she’d come in sooner.

“She knew she didn’t feel quite right,” Souther said.

Of course, she had no idea she would be the first to use the new smartphone app.

RIVETING SHOW

Cath lab director Lacretia Miles, RN, said watching the app in action, even at 4 a.m., was riveting.

“I was home in bed,” she said. “It goes off at 4 in the morning. This is the first time we’ve used it. You log in, you see who all has responded, everybody’s on the go, we’re all getting set up.

“Typically, knowing that the team has arrived, I’m good. I’m going back to sleep.”

But not this time.

“You can see when the team is assembled, when the cath lab is ready – all these times are right there, visual. I’m just lying there watching it on my phone. I should have just come on in.

“Finally,” she said, “I put the phone back down and then I hear the ding. I pick the phone up and think, ‘OK!’ The device was deployed, everything’s OK.”

Miles said the phone provides a record, too, of the entire procedure – what happened and when – giving the team an opportunity to review and see where they can do better.

“We actually have the person who’s monitoring, documenting, watching our procedures – they actually have their smartphone right there in front of them,” she said. “Typically whenever the doctor is getting close to going down with the balloon, someone in the room circulating will say, here’s our time, and that monitor person will actually push a button on their phone and that’s going to alert everybody that this is open, there’s our time.”

Cummings said that ability to review is extremely valuable.

“They’ve been transmitting EKGs from the field for five years now,” she said. “We had that. But this puts another layer and makes us more efficient. Hopefully the patient, the family and everyone can understand that we’re timing ourselves.

“We’re hitting on-scene, STEMI confirmed, arrival to the ER, cath team responding, cardiologist arrived, time they go to the cath lab, time the lesion is crossed, time the case is over – we’re watching every single piece.”

Watching lives get saved by highly-trained people – with some high-tech toys.

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Top Stories of 2013 #2: Bridgeport hospital saga continues

The sale of the Bridgeport hospital to Wise Regional Health System concluded in 2013, but the story began years earlier.

And at year’s end, it was still unfolding.

North Texas Community Hospital opened in August of 2008 in Bridgeport, a state-of-the-art facility licensed for 35 beds. By May 2009, it was already in default on bonded debt of $59.1 million.

After years of financial struggles but high praise from patients, the hospital declared bankruptcy in November 2012 – having already secured an agreement with Wise Regional that they would enter a “stalking-horse” bid of $20 million to purchase it.

When the bidding ended in late January 2013, Wise Regional was the only bidder.

On Feb. 4, WRHS was awarded the bid. The hospital remained open until the new owner took over March 27, and the emergency department never closed throughout the transition and renovations. It reopened May 7 as Wise Regional Bridgeport.

Almost all of the hospital’s 200 employees were offered jobs at either Decatur or Bridgeport.

However, as the year progressed, patient volume at Bridgeport did not meet expectations, and the campus lost an average of $350,000 a month. In November, the Wise Regional board voted to suspend inpatient services on Dec. 1.

At year’s end, the Bridgeport facility was handling emergency and outpatient procedures only, although it continued to maintain its license as a full-service facility in hopes that the cutback would be temporary.

Meanwhile, one of the biggest changes occurred behind the scenes: Wise Regional granted obstetric privileges July 29 to family practice physicians who met certain criteria in experience and training.

A significant portion of the Bridgeport hospital’s patient volume had come from deliveries performed by those doctors, who intially were not credentialed to deliver babies at Wise Regional in Decatur. The change opened the door for those doctors to bring their patients to Decatur – and eliminated a major bone of contention that had arisen between the two facilities over the years.

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Gift from the heart: Couple journeys from Grenada to Decatur for  cardiac implant

Gift from the heart: Couple journeys from Grenada to Decatur for cardiac implant

At about 1:45 Wednesday afternoon, Rennie Matthews’ heart stopped.

Fortunately for the 46-year-old builder, he was on the table in Wise Regional Health System’s’ cardiac catheterization lab, surrounded by doctors, nurses, technicians and millions of dollars’ worth of high-tech medical equipment.

The heart stoppage was a test. Cardiologist Dr. Trieu Ho had just implanted a bi-ventricular defibrillator in his chest.

Post Surgery Smile

POST-SURGERY SMILE – Rennie Matthews of Grenada was feeling considerably better Thursday after getting a pacemaker implanted at Wise Regional Health System the day before. Rennie and his wife, Dale, journeyed here from Grenada for the procedure. Messenger photo by Joe Duty

Big-screen monitors recorded the chaos as Rennie’s heart rhythm was disrupted. An instant later, the device administered an electrical shock that caused his body, although sleeping, to bounce on the table. His heartbeat resumed – and just like that, the procedure was over.

After an overnight stay in the hospital for observation, Rennie and his wife, Dale, went home the next day.

Sort of.

“Home” for Rennie and Dale is actually the island of Grenada, in the far southern reaches of the Caribbean just above Trinidad. They came to Decatur for the procedure and will return home a few days after Christmas.

The surgery, the implanted device, the hospital stay and even their room and meals while they’re here are all complimentary – an early Christmas gift from Wise Regional, some dedicated doctors, St. Jude’s Hospital, Candlewood Suites and a few other generous people.

Santa Docs

SANTA DOCS – Drs. Jason Finkelstein and Trieu Ho saw to it that Matthews got the medical care he needed. Messenger photo by Joe Duty

The story that links Grenada and Decatur starts with Dr. Jason Finkelstein, a partner of Dr. Ho and several other physicians in Advanced Heart Care here. Dr. Finkelstein, a native of Long Island, N.Y., went to medical school at St. George’s University on Grenada and for years has participated in a program that brings graduates back there for a week a year to do free cardiac care.

“I’ve been doing this since 2008, myself and about 12 other doctors,” he said. “We see patients there on a volunteer basis because there is no full-time cardiologist on the island.

“During my time down there, the citizens were nice to me. I just wanted to try and give back to them.”

RENNIE’S STORY

Grenada is a tiny island, 21 miles long and 12 miles wide, with only about 105,000 people. Originally a French colony, they have a democratic form of government and an economy that relies heavily on tourism.

CHRISTMAS GIFT – Dale Matthews waits as her husband gets ready for surgery Thursday. Messenger photo by Joe Duty

Most of the people speak English, but converse in a French creole patois. The temperature seldom gets below 80 or above 90.

Rennie’s wife Dale, a fifth-grade teacher, said it was November 2012 when her husband started complaining of shortness of breath. A local doctor said it was asthma and gave him inhalers, but he still had a hard time making the walk from the main road up to his house, about 120 feet.

“When he’s coming up the hill he would complain that he’s still having the shortness, and at work he couldn’t do anything much,” Dale said. “He would have to lie down and give orders.”

On Dec. 5 last year, they went to see Dr. Johansen Sylvester, coordinator of the adult cardiology program at St. George’s University.

“They admitted him, took his blood pressure, did an EKG, and then the doctor said it was really bad,” Dale said. “His heart was beating about 1 percent.”

They sent him home, planning to bring him back for further tests – but on Dec. 9 he suffered a heart attack.

“At about three minutes past six, I heard someone struggle to call my name,” she said. “When I look I saw him, so I rush him to the casualty. He was on drips, oxygen, in and out of hospital for about two or three weeks.”

In January, a doctor from Maine did an angiogram on Rennie – the first angiogram ever done in Grenada – and it revealed his heart muscle had been damaged by a virus.

“They said with a pacemaker, if he gets one in there, he would feel much better and be able to return to an almost normal life,” Dale said. “So we started working on that.”

Dr. Finkelstein wrote a letter to the U.S. Consulate in Grenada to help them get visas, and once those were secured he started organizing everything for the trip. The only thing Rennie and Dale had to pay for was their travel to the U.S. – and they took a loan from Dale’s credit union for that.

By that time, with the right combination of medications, his heart had improved to about 50 percent.

“He got about halfway there,” Dale said. “It appeared that he would be in shape to take a nice little surgery to implant the pacemaker. Dr. Finkelstein insured that everything would work smoothly – he dotted every i and crossed every t.

“Had it not been for him, this would not have been possible,” she added.

A DEFIBRILLATOR INSIDE

Those AED’s – automated external defibrillators – that hang on the wall in schools and most other public buildings are similar to what Dr. Ho placed inside Rennie’s chest, although Rennie’s device does more and is much smaller – about the size of a small garage door opener.

Hes Got Rhythm

HE’S GOT RHYTHM – Cardiologist Dr. Trieu Ho points to the bank of monitors as cardiac cath lab personnel get ready to test the pacemaker they’ve just installed in Rennie Matthews’ heart. Messenger photo by Joe Duty

To use the AED, the rescuer places electrode pads on the patient’s chest which sense the heart rhythm and determine if a shock is needed. If it is, the machine calculates the correct voltage and delivers it.

In Rennie’s case, the electrode now resides inside his heart, on a lead connected to the device which is under the skin, just below his collarbone. The pacemaker senses problems with the heart’s rhythm and corrects them. But if the heart stops, the device senses that, too, and becomes a defibrillator, administering a shock.

That’s what happened during the test.

The device was donated by St. Jude’s Hospital, delivered to Decatur by Jeff Cole, who worked hand-in-hand with the physician in operating and testing it during surgery.

It’s a procedure Dr. Ho does about 10 times a month here – but it would not be possible in Grenada.

“To get that care down there, they would have to travel to Barbados or Trinidad,” Dr. Finkelstein said. “These devices can cost $40,000 or $50,000. If they have to pay that out-of-pocket, it’s like seven or eight years’ salary for some of these people.”

Those in the cath lab wear lead suits because x-rays are taken throughout the procedure, to make sure the probe goes to the right spot in the heart. They insert it through a vein just below the left clavicle, and once it’s in place, they implant the device.

The only thing that’s visible is about a one-and-a-half-inch scar.

“The device is about half microchips and half batteries,” Cole said. He said the batteries should last eight to 10 years, and visiting cardiologists in Grenada will be able to test them when they’re down there. If he needs a replacement, he will have to come back to the U.S.

It’s a piece of equipment that will make his life better on a day-to-day basis, and save it if he has another heart attack.

“That heart stoppage we just saw, if it happened at work or on a ballfield, would be fatal 99 times out of 100,” Cole said. “With the device in place, it is survived 99 times out of 100.”

GRATEFUL FOR LIFE

Dr. Finkelstein said he expects the procedure to improve Rennie’s heart function and quality of life. The day after the surgery, it was apparent that was already happening.

“He said he feels like he’s 16 again,” Dale said on Thursday. “Every time when he wakes up he says, ‘I feel like when I just met you.’

“I’m just so glad that Rennie will be able to live again. If we hadn’t been given this opportunity, I don’t think he would be with us much longer. Since he is the main breadwinner for our family his illness had been very hard.”

Rennie and Dale have two children, a son who is 21 and a daughter who is 15. The trip falls during Dale’s Christmas vacation from school, so she doesn’t miss any time at work. School starts again Jan. 6.

“I have prayed for my kids and left them in God’s hands, so I’m not worried,” Dale said. “I get to say hi to them at least once a day.”

She’s delighted Rennie will be able to start 2014 on the road to recovery and extremely impressed with the hospitality they’ve seen in Decatur.

But they’re not huge fans of the weather.

“Everyone in Texas has been very nice – but it is a bit colder than home,” Dale said.

Warm hearts, however, make a big difference.

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Wise Regional Health System looking for better financial news

As 2013 draws to an end, Wise Regional Health System has several things going on that should improve the hospital’s financial fortunes in 2014.

During a board meeting Monday evening, trustees noted that the system’s consolidated loss for November was $98,000 – despite a $450,000 loss at the Bridgeport campus, which joined WRHS in March.

Chief Financial Officer Jim Eaton told the board the receipt of 1115 waiver funds during November helped offset operational losses that came about as a result of lower patient volumes across all lines of service. But losses at the Bridgeport campus are expected to lessen in December, after inpatient services were suspended there Dec. 1.

The Bridgeport facility will continue to offer emergency services, imaging and outpatient services.

Eaton noted that no full-time staff were laid off as a result of the move, with those Bridgeport employees filling open positions at the Decatur campus.

Board members also heard a report on the system’s 2014 worker’s compensation insurance policy. A new policy for 2014 was approved and although the premium is up 12 percent over 2013, it was noted that WRHS has seen a 25 percent increase in the number of employees since that policy was purchased.

Texas Hospital Insurance Exchange, the successful bidder, will provide not only the policy, but comprehensive audits and evaluations of the hospital’s existing safety measures to help minimize employee injury risks.

Wise Regional CEO Steve Summers gave the board an update on development of Parkway Surgical Hospital, where construction continues. He said the surgical and catheterization laboratory equipment should begin moving in around the end of December, and construction should be complete by the end of January.

The 29,000 square-foot facility is located on North Tarrant Parkway, not far from the intersection of U.S. 81/287 and Interstate 35. The inpatient surgical facility that will include four operating rooms, two procedure rooms and 12 inpatient beds with a laboratory, radiology and preoperative services and an emergency room.

It will provide spine, orthopedics, cardiology, plastic surgery, pain and gastroenterology services and is due to open in March.

In addition, Wise Regional continues to work towards refinancing approximately $55 million of its bonded indebtedness – approximately 75 percent of the facility’s debt. Rating agencies have been invited to consider setting an investment-grade bond rating for the debt, in an effort to lower the hospital system’s interest costs.

STAFF APPOINTMENTS APPROVED

The board also approved several new appointments to the medical staff, based on the recommendations of the Medical Executive Committee, and accepted the medical staff’s annual review of various medical service contracts.

New appointments were approved for:

  • Nathaniel Berrios, PA, Allied Health in surgery;
  • Jenna Chapa, NP, Allied Health in the Emergency Department;
  • Michael Fuller, PA-C, Allied Health in surgery;
  • Theodoor Hancke, CRNA, Allied Health in anesthesia;
  • Samantha Mullins, DPM, Active Staff in Podiatry;
  • Syed Rahman, MD, Active Staff in the Emergency Department;
  • John Douglas Ramey, CRNA, Allied Health in anesthesia; and
  • Robin Weerts, CRNA, Allied Health in Anesthesia.

The board tabled action to modify the medical staff bylaws until its January meeting to allow more time for responses from staff members.

Hardware, software purchased

The board approved an upgrade for both the information hardware and software that interfaces with the Soarian electronic clinical record system and the financial and patient admission system.

The $251,704 upgrade, which was budgeted, enables Wise Regional to continue implementation of the electronic health information system. Since the federal government began encouraging health care providers to adopt Electronic Health Records (EHR), usage of existing hard and software systems has increased dramatically.

EHR Systems are a key component in modernizing health care delivery by providing better-coordinated care – which can both improve patients’ health and save money. Wise Regional effectively began use of the Soarian electronic health record system in November, with significant help from the medical staff.

The Board also approved a $259,435 budget item for upgrades to multiple information systems required to meet Stage 2 Meaningful Use requirements in 2014. These include modules for the Lab, Pharmacy, Soarian Clinicals and Data Management.

OTHER BUSINESS

Summers told the board the 163-page initial draft of the Community Health Assessment that was conducted earlier this year has been delivered and is under review by key hospital personnel. Full results should be available soon at WiseRegional.com soon.

While much of the report is technical and includes census and Department of Health statistics, it will help to identify areas of need within the community, Summers said, that are specific to health care.

Bruce Miller, vice-president of network development for Baylor Quality Alliance, gave the board an overview of the recent merger between Baylor Health Care System and Scott & White Healthcare. The newly branded BaylorScott & White Health was born out of growing pressure to demonstrate value and improve outcomes while lowering total health care costs.

Those are issues facing most large health care systems in the nation today.

The board’s next meeting will be Monday, Jan. 27 at 6 p.m. in the hospital’s administration board room.

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Inpatient services to be suspended at Bridgeport

Inpatient services to be suspended at Bridgeport

Wise Regional Health System will suspend inpatient services at its Bridgeport campus effective Dec. 1.

That announcement came in a news release Tuesday after the hospital board met Monday evening. The matter was not on the board’s agenda.

Wise Regiounal Bridgeport Campus

Wise Regional Health System Bridgeport campus

According to the news release, the change will affect only the medical/surgical inpatient unit and the ICU. The facility will remain open, focusing on outpatient services including surgery, radiology and emergency services – but patients who need an overnight stay will be transferred to Decatur.

The former North Texas Community Hospital in Bridgeport opened in August of 2008, but by the following May was in default on $59.1 million in bonded debt. In Nov. 2012, the facility filed for bankruptcy.

With the bankruptcy case in federal court in Fort Worth, Wise Regional was the only bidder and purchased the hospital for $20 million in February of this year. The Decatur-based hospital system assumed ownership on March 27.

Throughout the transfer, the hospital’s ER department remained open, although Wise Regional did shut down much of the facility for remodeling and upgrades before opening it back up to inpatient services and surgery on May 7.

“We had hoped to see enough inpatient volume at the Bridgeport campus to provide a good level of support for the facility,” said Donna Stowers, the Bridgeport hospital’s administrative director. “An Intensive Care Unit was opened at the end of September to further encourage inpatient admissions to the facility. Unfortunately we have not seen the patient volumes that are necessary to make inpatient services a financially viable effort.”

WRHS expected to encounter losses on operations, but CFO Jim Eaton said the Bridgeport campus has continued to lose about $350,000 per month. Inpatient volumes, which were projected in the 8 to 10 patient-per-day range, have instead remained at 1 to 2 patients-per-day.

In presenting the budget for the upcoming fiscal year at Monday’s board meeting, Eaton projected a loss of $2.6 million for the Bridgeport facility in 2014 as currently operated. Potential changes were noted, however, in the executive summary that accompanied the 20-page document.

“Inpatient surgeries and patient admissions have been budgeted for 192 and 864, respectively,” the summary said. “This is a significant growth from current volumes and the opening of the critical care unit is expected to help generate these volumes.”

The report went on to predict that “ancillary services such as respiratory, pharmacy, imaging and laboratory” would also see growth if those patient volumes materialized. “At these budgeted amounts, it is worth operating at the current level of service,” the report stated.

But it sounded a cautionary note.

“In the event that inpatient services are curtailed at Bridgeport in 2014 due to continuing low volume, that patient volume would be picked up at the Decatur campus, but at a lower overall cost,” it said. “In that event, there would not be a negative budget impact.”

The Bridgeport hospital was originally licensed for 35 patient beds. Before the ownership change, it had 200 employees – 130 fulltime. Wise Regional was able to take on almost all of those employees who wished to stay.

In fact, Wise Regional added the equivalent of 243 full-time employees through 2013, primarily due to the acquisition of the Bridgeport campus.

Steve Summers, chief executive for WRHS, said all the equipment at Bridgeport will remain in place and its license to operate as an inpatient facility will be maintained.

“Our goal and hope is that this is a temporary suspension,” Summers said. “We are committed as an organization to providing quality care in Bridgeport and health care services which are needed and will continue to do so.”

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Budget projections top $195 million for 2014

At its meeting Monday night, the Wise Regional Health System board of directors approved a budget of nearly $196 million for 2014.

With expenses projected at just over $186 million – 25 percent more than in 2013 – a net operating profit of $10.15 million was budgeted for the system, which operates hospitals in Decatur and Bridgeport as well as several ancillary facilities.

Revenue was projected to rise by 20 percent over 2013.

The budget numbers were based on the Bridgeport hospital continuing to operate as a full-service facility – but that situation changed as of Tuesday when it was announced that inpatient services would be suspended there effective Dec. 1. (See story on page 1.)

Bridgeport was projected to generate $14.77 million in adjusted revenue for 2014, with expenses of $17.4 million – a $2.6 million loss. That situation will change after the cutback announced Tuesday.

Also on the horizon in the coming year is the projected opening of the WRHS Parkway Cardiovascular and Surgical Hospital on Interstate 35 in Fort Worth. That facility is expected to open its doors in March and account for 858 outpatient surgical procedures in nine months of operation in 2014.

With the start-up expenses incurred prior to opening, Parkway is projected to break even in 2014 but should become profitable in 2015 with a higher percentage of private-pay patients than the Decatur hospital.

More good financial news came in an announcement that Wise Regional Health Foundation will purchase a “Hologic Selenia Dimension” digital mammography unit to replace existing equipment that is seven years old.

The new piece of equipment should increase image quality and provide better service for WRHS patients.

The machine will cost $245,000. The board expressed its appreciation of the Foundation board for its efforts to help with the cost of necessary equipment for the hospital and community.

NEW RECORDS SYSTEM UP AND RUNNING

Directors also were told that the hospital this month fully implemented its electronic medical record system. Physicians are now using the electronic system to manage their patients’ care within the hospital.

With the first round of the hospital’s construction bonds callable in 2014, discussions are underway about refinancing them to achieve an interest savings.

CEO Steve Summers told the board the refinancing discussion is ongoing and said they would be asked to participate in those meetings in January. The goal is to attain an investment-grade rating on existing bonds.

The board voted to retain the existing officer positions for next year, with Andrew Sanford as president, Jay Bearden as vice president and Debbie Waggoner as secretary.

They also approved several new appointments to the medical staff, following the recommendations of Wise Regional’s Medical Executive Committee.

New appointments included:

  • Clay H. Brown, MD, (consulting) anesthesia;
  • Ricky Childers, DPM, (active) podiatry;
  • Stuart Connell, MD, (active) pain management;
  • Michelle Doyle-Griffith, CRNA (allied) anesthesia;
  • Patrick Evans, CRNA (allied) anesthesia;
  • Meagan Johnson, PA, (allied) surgery;
  • Khuram Khan, DO (consulting) anesthesia;
  • Sharon McLemore, NP (allied) family medicine;
  • Natalia Tan, PA-C (allied) surgery.

Summers provided an administrative report that included updates on the hospital’s continuing support of the Wise County Youth Fair Champions Club and a review of an article that discusses the national health care scene.

He also gave the board an overview from board meetings of both the Wise Regional Health Foundation and Wise Clinical Care Associates.

The board also:

  • delegated the human resources committee the authority to establish an Executive Compensation Plan
  • in consideration of the upcoming holiday, moved its December meeting date to Dec. 16

The board approved the following on the consent agenda:

  • A management services and equipment lease agreement with MediVest Denton LP, a Texas limited partnership (“MVP”) for MRI imaging services in Denton.
  • The sale of CT currently located at WRHS freestanding imaging center in Bridgeport for $65,000.

The next meeting is 6 p.m. Monday, Dec. 16, in the administration board room at 609 Medical Center Drive in Decatur.

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Staff jumps into action during drill

Staff jumps into action during drill

How do you respond to an emergency during an already life-threatening situation?

Thursday afternoon, on the third floor of Wise Regional Health System (WRHS) in Decatur, doctors and nurses were operating on a patient in a sterile operating room. An employee noticed an autoclave sparking in what appeared to be a small electrical fire.

Climbing to the Top

CLIMBING TO THE TOP – Decatur firefighter Alex Brown climbs the stairs to the third floor at Wise Regional Health System during a drill Thursday. Messenger photo by Joe Duty

Moments later a sudden explosion rocked the third floor, blasting a huge hole in the operating room, seriously injuring doctors, nurses and even the patient who was undergoing surgery.

From the third floor window, Decatur Fire Hall could be seen opening its bay doors on a faraway hill. Firefighters and other first responders would arrive in minutes, but every second is crucial, and hospital staff has to know how to take care of its patients and its employees immediately.

PRACTICING PROCEDURE – Staff at Wise Regional Health System participated in a drill Thursday that simulated a fire in the operating room. Pictured (from left) are Nancy Neff, RN; Whitney Wiggins, RN; Cheryl Maietta, RN; Charlene Berg, CRNA; Kellie Romines, RN; Derek Wilson, RN; Brooke Arrington, RN; Juanita Schrader, RN; and Aaron Cortez, who acted as a patient. Messenger photo by Joe Duty

“We do these types of drills so we are already prepared and trained in case something like this does happen,” said Shannon Puphal, WRHS spokesperson. “We do this to check our processes.”

The staff went to great lengths to make the mock explosion as realistic as possible. The faces and arms of nurses and doctors in the operating room were marred with makeup resembling horrid burns. Like clockwork, additional staff rushed in. A table equipped with everything needed to keep the surgical patient alive is rolled in. Other staff quickly takes stock of those injured and dying. Within 20 minutes, all seven injured parties have been transported to the unaffected end of the hospital and have been seen by a doctor.

“You have to do these to test your resources and response,” said Wise County Deputy Fire Marshal J.C. Travis, who was on hand observing tactics and responses.

There are seven operating rooms at the hospital, not to mention many other patients and staff scattered throughout the complex. Disasters can and do strike medical facilities.

The WRHS Fit-n-Wise complex in Decatur was devastated by a tornado in October of 2001.

Wise County Fire Marshal Chuck Beard has responded to three hospital fires during his career. He looked on as a team of Decatur firefighters stormed up a flight of stairs to respond to the mock explosion.

“The biggest difference between these scenarios and if a structure fire really happened is the amount of chaos,” Beard said. “But these help identify any types of failing there may be. Not just with the fire department, but with the hospital staff as well, from the top down.”

Puphal said the hospital staff did identify a couple of areas to help improve response to a real disaster. The hospital plans to work with Decatur Fire Department to identify stairwells by numbers rather than by direction such as east, west, etc.

Staff also discovered that certain patient evacuation sleds are easier to maneuver down stairwells than others, prompting the hospital to increase the number of those sleds on upper floors.

“Overall, the department directors felt the drill went well,” Puphal said. “Protocols were followed, and staff and were knowledgeable on hospital policies and procedures.”

A more comprehensive drill involving more county agencies is likely planned for the future.

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