Richmond University Medical Center: Transitioning to Greatness - RedCoat Publishing - Inside Healthcare

A bigger name doesn’t always mean better healthcare. Richmond University Medical Center had already been functioning as an independent organization when it legally gained its independence in January 2008, but to the public at large, the legality only signified a separation from a larger organization. The administration of the 450-plus-bed acute care hospital had been standing on its own for years prior.

Richard Salhany, COO

“The name change from St. Vincent’s Medical Center to Richmond University Medical Center occurred when we were purchased by Bayonne Medical Center’s parent company, Bridge Regional Health System, in 2006,” said Richard Salhany, COO since 2005. “During that time, we were working toward becoming an independent organization.”

Part of the goal included investing in the hospital’s infrastructure and physical plant to ensure the name change and independent designation would not overshadow the hospital’s ability to provide high quality healthcare to the community. For Richmond University Medical Center, it meant investing in the hospital’s gateway to its community: its ED. As part of the improvement of its ED services, the administration changed the hospital’s medical practice management group to EMA (Emergency Medical Associates).

“We put an RFP out to three groups, and EMA came back with the most significant improvements in IT,” Salhany said. “We wanted to set a precedent. We wanted to be the best ED, and we felt EMA would bring the best in terms of clinical practice and IT.”

With the help of the hospital’s investment in IT, EMA automated the ED from a clinical IT perspective. When patients walk in the front door, they are tracked, their orders are put into a system, and the system develops a floating record that travels with the patient throughout the hospital. When the patient is discharged, he or she automatically receives printed discharge information.

“It makes it easier for our nurses to receive the ED patients,” Salhany said. “Rather than trying to decipher handwritten notes, they review the EMR, review the orders, and know exactly what next steps should be taken. If they’re admitted, the patients are medically cleared and can go right into their room. They can be quickly treated in accordance with the care plan, in consultation with the attending physician.”

In addition, EMA’s ED physicians are board certified, and many are double board certified in emergency medicine and critical care, which has improved patient turnaround times and primary-care physician satisfaction. The hospital is also investing in medical practice communication software to enhance the ED’s relationship to the hospital’s ambulance and emergency first community responders.

“We’ve invested in bedside registrations so that rather than the ambulance or critical care patient having to wait in a triage area to fill out paperwork, registration takes place at the bedside with rolling carts. We recently installed a mini PACS in our ED and, because we’re a state-designated stroke center, we acquired a 16-slice CT. We’re starting to track patient satisfaction scores and have already seen a bump in physician satisfaction scores, but we’re not done yet.”

The right direction
Salhany is aware that improving patient satisfaction requires more than physical plant investments to the ED, which is why the majority of Richmond University Medical Center’s changes of the past two years have gone far beyond its ED. In addition to the main facility, the hospital has two endoscopy units, one within its walls and another at the nearby Bayley Seton campus. The administration’s goal is to consolidate the two units and eventually evacuate the Bayley Seton location, and an award from New York State Senators Lanza and Marchi made it possible.

The $1.2 million project will consolidate all of the hospital’s endoscopy capabilities on the first floor in a five-room, state-of-the-art endoscopy suite. Larger rooms will enable patients and their families to stay together while at the hospital, and the February purchase of endoscopy software means physicians can electronically report their findings immediately after the procedure. “The Web-based product makes it possible for physicians in their offices to share or print out the report for families and patients,” Salhany said. “We expect the unit to be finished this June.”

In addition to physical improvements, the hospital was one of 37 to join the Greater New York Hospital Association’s CLAB (central line associated bloodstream infections) initiative to develop best practices and decrease the number of central line infections in ICUs. Since joining in 2006, the hospital has reduced its central line infection rate from 4% per 1,000 admissions to 0.8% per 1,000 admissions.

The hospital’s patient satisfaction scores have also improved, in part due to initiatives such as serving breakfast to parents in the pediatric department and renovating the waiting spaces in the ambulatory surgery department. Its maternity unit, in which the hospital developed 14 private suites and eight double rooms with wood floors and private bathrooms, the hospital has ranked in the 90th percentile with Press Ganey. And although the hospital has taken significant steps to improve, Salhany knows there is much more to do.

This year is a transition year for the hospital, he said, during which the hospital is re-establishing itself within the community with its Everyday Miracles at Richmond University Medical Center campaign. “Changing the culture to be more patient-focused while renovating the facility and infrastructure is a multi-year process. To do it faster requires more of a capital investment, but when we hear our patients say they were treated with courtesy when they walked down the hall, we know we’re taking steps in the right direction.”

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