American Fork Hospital: Teaming Together
Spotlights
Written by Amanda Gaines   
Tuesday, 01 July 2008
American Fork Hospital: Teaming Together - Health Executive - RedCoat Publishing
Senior leaders at this community hospital explain why approaching healthcare as a team ensures the best clinical and cost-efficient outcomes.
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Collaboration is key at Intermountain Healthcare’s American Fork Hospital. Located in one of the fastest growing counties in Utah, this 120-bed community not-for-profit hospital takes pride in its successes because each member of its “family” has played a part.

“No one individual can possess all of the expertise or understanding to meet the vital needs of our patients and community,” said Michael Olson, administrator and CEO at American Fork Hospital. “Bringing people together as a multidisciplinary group with various levels of expertise is critical to getting the best outcomes.”

American Fork Hospital: Teaming Together - Health Executive - RedCoat Publishing
Ann Eves, nursing administrator; Michael Olson, administrator and CEO; and Sheralyn Hess, department manager for the mother/baby unit and nurseries
Such was the philosophy when, in 2002, the hospital upgraded the infrastructure and protocols of its women’s services to better accommodate the roughly 3,000 babies it delivers each year. The hospital expanded from 16 semi-private rooms to 27 private rooms, expanded its labor and delivery department, and upgraded its nursery from a Level II-A to a Level II-B NICU.

Although the upgrade was substantial, the hospital soon heard that more was needed to satisfy the needs of its community. “Pediatricians were concerned because we were sending so many of our newborns with Respiratory Distress Syndrome (RDS) to our tertiary NICU at Utah Valley Regional Medical Center (UVRMC), which is 25 minutes away,” explained Sheralyn Hess, department manager for the mother/baby unit and nurseries at American Fork Hospital. “We needed to work harder to ensure we were taking the best care of these babies, giving them great outcomes, and keeping them closer to home.”

Reducing risk
With input from pediatricians, nurses, respiratory therapists, and neonatologists, the hospital developed a newborn executive team and began investigating the number of babies that were being transported to the NICU with RDS. In 2002, the hospital found it had transported 78% of those babies to UVRMC.

“We began looking at how those babies were treated and tried to develop a best practice,” said Hess. “We developed an early lung recruitment protocol that included using a nasal CPAP machine to recruit the lung.”

The initiative began in October 2003 and included extensive training for all nursing staff, respiratory therapists, and pediatricians who would be caring for these infants. Between October 2003 and January 2005, American Fork Hospital’s RDS transport rate dropped to 29%. Not yet satisfied with its results, the team modified the protocol so that babies would be given surfactant to help with recruiting the lung. The result: during 2006, the hospital’s RDS transport rate dropped to 19%.

By 2007, the transportation rate for RDS had dropped to 14.6%. After further adjusting the protocol to include putting babies on CPAP lung recruitment within the first 30 minutes of life, the hospital’s rate of transportation for babies suffering from RDS dropped to 9% by February 2008. But that’s not all.

“The lengths of stay for babies who still need surfactant and are admitted to the Level II nursery have also dropped dramatically,” said Hess. “They were averaging roughly 10 days, and this year the average is down to seven days.”

Cost-efficient care
In addition to developing a protocol that’s been presented at NANN (National Association of Neonatal Nurses), AWHONN (Association of Women’s Health Obstetrics and Neonatal Nurses), a national respiratory conference, and a national neonatal conference, the newborn executive team’s successes address a greater concern for new parents, payors, and providers across the nation—cost efficiency.

“Throughout our community, facility, and Intermountain Healthcare, we want to do the best for patients at the lowest costs,” said Ann Eves, nursing administrator at American Folk Hospital. “We’re all feeling the impact of higher medical costs. As a team, we’ve committed to finding ways to save money and become as efficient as possible.”

The results of this effort are in the numbers. In 2005, approximately $2 million was saved in costs for transportation, length of stay, and the shortened length of ventilator dependency. “According to our neonatologist, the babies we do have to send to UVRMC are typically off the ventilators within 12 to 24 hours of their arrival,” said Hess.

The long-term gain for the babies and their families is that these babies will live healthier lives as they grow up. Most babies who are on ventilators for an extended amount of time have healthcare issues throughout their lives. “These babies won’t see those long-term problems because of how they were handled immediately after birth,” said Eves.

Head of the pack
American Fork Hospital’s ability to work as a team has placed it at the head of the pack for piloting new processes within the Intermountain system, which includes 20 healthcare facilities. The hospital is currently piloting the beta tests for an electronic clinical information system in the ED, which is the result of a partnership between Intermountain Healthcare and General Electric.

“The system is the precursor for a future hospital EMR,” said Olson. “We’re the first location where this system is being tested, and we’re ironing out the first phase of it in the ED.”

GE selected Intermountain based on its past ingenuity, and Intermountain selected American Fork Hospital to represent the system for the exact same reason, citing the success of pilot testing Intermountain’s bar-coding medication administration. “We were the pilot for implementation of that process in our system,” said Olson. “We’re often selected to pioneer new procedures or technologies because our managers, department leaders, physicians, and employees embrace change as a team.”

As a Magnet hospital with one of the first cancer centers in Utah to be affiliated with the Huntsman Cancer Center, a prominent cancer organization in Utah, it’s clear American Fork Hospital embraces clinical excellence as a team as well. “Intermountain frequently looks at this hospital as being the perfect size and culture to pilot new projects,” said Olson. “We believe it’s important, we pride ourselves on it, and we all work hard at maintaining that standing.”
 
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