HGH Board Brief September 24, 2019

Trustees present: JoAnn Casalez, Chairman; Bill Hammargren; Jennifer Hood; Ken Tipton; and Gene Hunt. Trustees not present: Michelle Miller, Secretary.

Medical Staff-Hospital Department Reports

Administration Department Report: CEO

Emergency Department Update

Dr. Martin Johns from Envision Healthcare, Humboldt General Hospital's Emergency Department physician services provider, updated board trustees on the current state of the ED. Dr. Johns, who acts as the medical director for the HGH ED, was accompanied by Envision CEO Andy Scroggins. Dr. Johns shared operational successes with board members as well as observations from an operational assessment conducted earlier this year. He noted that:

  • All patients are brought to an open bed after nurses are notified of patient arrival;
  • Patients are examined by the ED physician quickly after arrival;
  • Interactions between the physician, staff and patients is pleasant and professional;
  • There is excellent teamwork between departments;
  • The HGH percentage of patients who leave without treatment is better than the national average of low-volume hospitals.

Dr. Johns also shared results of a time study comparison from March-May 2019 and then from July-September 2019; Dr. Johns began helping administratively in July. He noted that the results show an impressive amount of growth for the HGH ED:

  • Arrival to provider time improved by 17 minutes
  • Arrival to exit from the ED for discharged patients improved by 2 minutes
  • Arrival to exit from the ED for admitted patients improved by 3 minutes
  • Arrival to exit from the ED for transferred patients improved by 39 minutes

Dr. Johns noted that he has worked closely with "excellent [ED] nurse manager" Robyn Dunckhorst; he also has had several meetings with the ED physicians, HGH Interim CEO Karen Cole and EMS where he has stressed customer service, accountability and consistency with the physicians.

Overall, Dr. Johns said the improvements speak for themselves. In surveying hundreds of ED patients over the past several months:

  • Patient satisfaction with the ED physician improved from 70% to 79%
  • Patient satisfaction with the overall ED visit improved from 70% to 75%
  • Patient's recommendation of the ED improved from 97% to 98%

Dr. Johns said together, Envision and HGH have set goals to continue to challenge ED physicians to provide excellent care, empathy, and compassion 24/7 despite high acuity. Additionally, physicians will be trained on the hospital's new electronic health record system, which will go live in November. Dr. Johns said the two entities are committed to press the level of excellence at HGH.

Quarterly Security Update

HGH EMS Rescue Chief Sean Burke presented board members with security data for July, August and September. Chief Burke said HGH's security personnel have done an "astounding job" in their positions, especially in ensuring that people "who do not have official business at HGH" are cleared from the building. Before HGH contracted with its security detail, the hospital averaged 99 assistance calls to the Winnemucca Police Department each month; now that number has dropped to 7. Overall, security personnel provide assistance with suspicious activity, open doors, patient/legal standby, facility removal, combative patients, patient/staff escort, patient/staff help and alarm response.

Cerner Project Report

HGH Chief Financial Officer Sandi Lehman reported on the Cerner Electronic Health Record conversion. She said that all order sets have been submitted and are being built in the system; as a result of staff's efforts, this process is actually ahead of schedule. Charge unit testing is about 80% complete; it is expected to be 100% complete by the end of the Integration Testing 2 event. Sandi said HGH is working on engaging with Quest for laboratory results as well as on a radiology-based interface with Carestream. The next event, IT2 will begin on October 1, 2019. All other metrics are on target.

CEO Report

Crews at work converting the PT-Cardiac Rehab space into the new HGH Pharmacy Department

HGH Plant Facility and Safety Director Duane Grannis updated the board on the remodel-expansion of the former Physical Therapy and Cardiac Rehab departments into the new Pharmacy space. Duane said construction is on schedule with all wall changes complete. Crews continue to work on HVAC and electrical systems. Additionally, from September 23 through October 4, the HGH Corner Cafe will be closed so construction crews can complete HVAC work in the ceiling as well as add new LED lighting.

CEO Cole updated board members on current physician recruitment efforts:

  • Dr. Alex Curtis, a family practice/OB physician, began seeing patients September 3.
  • Dr. Rommel Adajar, an internal medicine specialist, is expected to arrive at HGH on October 7.
  • Welcome receptions for each new physician have been scheduled at 5 p.m., just prior to each month's board meeting. Dr. Adajar will be welcomed in October.

CEO Cole discussed several family practice/OB physicians, including:

  • A family practice/OB physician who will come for a site visit September 15-17. The Wisconsin Critical Access Hospital, where she has worked since 2012, is now closing its OB unit. Her husband is an engineer and she has one son in college.
  • A Washington family practice/OB physician who is also looking for a practice opportunity where she can perform C-sections. Her husband is a paramedic and they have one daughter.
  • A family practice/OB physician who is currently serving in in the military and will be available in 2021. She graduated from Howard Medical School and has completed a Family Medicine Obstetrics Fellowship at Fort Hood. She is looking to do full-spectrum family medicine and said she would find a 9-5 job "boring." She also served in Afghanistan as a NATO advisor.
  • A family practice/OB physician who is currently completing a family residency program and would be available in 2020. She is scheduled for a video interview on October 26.

CEO Cole said the hospital will keep moving forward with recruitment until physicians have signed contracts and are physically in place.

CEO Cole updated the board on several other projects:

  • Optimum HRIS, a payroll and HR software, is scheduled to go live in January with the first employee payroll.
  • Humboldt General Hospital is currently bidding out its health insurance. She said board members will be presented with a staff recommendation at their October board meeting.
  • Landon Mouritsen has joined HGH as a staff CRNA; HR is actively recruiting for a third position.

CEO Cole also shared some thoughts regarding a community wide active shooter drill that took place on Saturday, September 21. She said the collegiality between agencies, including HGH EMS Rescue, HGH, the Winnemucca Police Department, the Humboldt County Sheriff's Office, Winnemucca Volunteer Fire Department, Winnemucca Rural Fire Department and the Humboldt County School District, was very impressive. She thanked EMS Chief Sean Burke and Community Education and Development Director Nicole Maher for organizing an after action review. She said that while everyone identified challenges, each was met as an opportunity for further growth and development. She also thanked the newspaper for covering the event.

HGH Plant Facility and Safety Director Duane Grannis updated the board on the transformation of the Physical Therapy and Cardiac Rehabilitation departments into the new Pharmacy Department. Duane said it is great having Sletten Construction back on site, led by Rick Reynolds. Already, crews have 90 percent of the demolition work done, including two days of cutting concrete. They are preparing to begin framing walls in the next few days. There have not been any issues with infection control.

Medical Staff Report

Dr. Paul Gaulin, Humboldt General Hospital's Chief of Staff, reported that for the first time in about nine years, Humboldt General Hospital performed surgeries in both OR suites at the same time, thanks to the addition of new CRNA Landon Mouritsen and current CRNA Mark Reyka.

Consent Agenda

Board trustees approved the meeting minutes for the August 27, 2019, meeting. Additionally, board members approved medical staff applications for appointments, reappointments, provisional and temporary privileges for 10 medical providers.

Financial Reports

HGH Chief Financial Officer Sandi Lehman shared highlights from the August financial statements.

For August, patient days were over budget for all areas of the hospital with the exception of OR cases. Month-to-date net loss from operations was $752,467 compared to a budgeted loss of $55,887. August's operating revenues were higher than budgeted by approximately $323,000, while operating expenses were higher than budget by approximately $1 million. Sandi said the higher-than-normal expenses could be attributed to contractual adjustments; July PERS and locum invoices that were posted to August; an increase in locum expenses for the Walk-In Clinic and a sign-on bonus; an increase in supply expense for both Pharmacy and OR; and unbudgeted/over-budget contract labor expenses in ICU, OB, OR, Recovery, Respiratory and ER. For the month, non-operating revenues were approximately $546,000 over budget and net income of $188,469 was approximately $546,000 over budget.

Business Items-Other Reports

1. Hospital Administration-EMS / proposal to purchase eleven new cardiac monitors to replace outdated-unsupported cardiac monitors/ EMS Director-Administration - Board members tabled this item at the request of CEO Cole. She explained that the bidding process for new cardiac monitors for EMS revealed significant differences in products. EMS would like more time to investigate which products would best suit its needs. In the meantime, the agency's current cardiac monitors are completely viable.

2. Hospital Administration-Radiology/ proposal to purchase Carestream interface for Cerner project in the amount of $110,000 / CFO-Administration - Board members unanimously approved the purchase of the CareStream interface at a cost of $107,833. The interface will provide an electronic means of communication between HGH's in-house Radiology management system and Cerner's Community Works cloud-based application.

3. Hospital Administration-Pharmacy / proposal to purchase casework for pharmacy remodel project / Administration-Pharmacy Director - The board unanimously approved the purchase of casework for the Pharmacy Department expansion and remodel at a cost of $116,854. Additional office-type furnishings will be ordered through the hospital's customary vendors at a significant cost savings.

4. Hospital Administration / proposal to engage the professional services of and enter into an agreement with CTA Architects to provide design and other services for the cafeteria remodel project / Administration-Owners Representative - The hospital board unanimously approved an agreement with CTA Architects, not to exceed $25,000, to plan and design an expansion-remodel of the hospital cafeteria.

5. Hospital Administration / proposal to engage the professional services of and enter into an employment agreement with Subha Rajan, M.D. to provide family practice and obstetrics services / Administration - Hospital trustees unanimously approved a proposal to engage the professional services of and to enter into an agreement with Subha Rajan, MD, to provide Family Practice/OB services at Humboldt General Hospital.

6. Hospital Administration / proposal to engage the professional services of and enter into an independent contractor agreement with Shane Draper, Ltd. to provide podiatry services / Administration - Board trustees unanimously approved a proposal to enter into an agreement with Shane Draper, Ltd., to provide clinic and surgical podiatry medicine services at Humboldt General Hospital. HGH will pay a flat fee of $10,000 for three days of services each week, and will bill and collect for all services

Trustee Comments

Chairman JoAnn Casalez appointed Trustee Gene Hunt to review the board's bylaws and bring a report back to trustees on proposed changes.

Trustee Jennifer Hood shared that as of the evening's board meeting, she was retiring from the board; she is also moving from the community at the end of October to be closer to family. She thanked Chairman Casalez, CEO Cole and Humboldt County's citizens for their support.

Next Meeting

The Humboldt County Hospital District Board of Trustees will meet next in regular session at 5:30 p.m. Tuesday, October 22, in the Sarah Winnemucca Conference Room.

Meeting agendas, board minutes and more will be/are available at: